Progressive cytopenia, development of MDS and increased percentage of bone marrow blasts, abnormal karyotype (3q+, −7,/7q, complex karyotype), RUNX1, and biallelic TP53 mutations are factors that identify risk patients and support the early indication of HSCT in IBMF (1, 6). The gene discussed is RUNX1; the disease is myelodysplastic syndrome.