The impact of mutational VAF in MDS and its association with prognosis has shown to be different between the specific genes and the co-mutated genes present; for example, in one study, the NRAS gene was associated with leukemia transformation regardless of whether it had low or high VAF [34]; in another study, co-mutation of EZH2 with NRAS mutation was associated with poor overall survival regardless of the mutational burden of NRAS [35]. This evidence concerns the gene EZH2 and myelodysplastic syndrome.