As shown in Figures 1G–I, the morphological assessment exhibited increased cellularity and dysplasia of erythroid and myeloid cells (hypogranular neutrophils, abnormal red blood cells (RBC) of mild anisocytosis and basophilic stippling); FCM showed 11.5% lymphoid cells in the BM; cytogenetics ascertained the abnormal karyotype of 42~46, XY, del (3) (p24), -5, +add (8) (q24.1), -17, add (18) (q23), +mar, inc[cp9]/46, XY [11]; MDS-associated genes revealed the TP53 mutation (c.818G>A, VAF of 45.3%, c.659A>G, VAF of 17%, c.636del, VAF of 11.7%) and DNMT3A mutation (c.939G>A, VAF of 13.3%). Here, DNMT3A is linked to myelodysplastic syndrome.