Clonal dynamics evaluation using whole-exome and targeted sequencing of 699 patients compared secondary acute myeloid leukemia (sAML) to high-risk MDS and highlighted several newly acquired mutations in FLT3, PTPN11, WT1, IDH1, IDH2 and NRAS. On the other hand, comparing high-risk MDS with low-risk MDS revealed mutated genes with weaker impact on sAML progression and overall survival (OS) including TP53, GATA2, KRAS, RUNX1, STAG2, ASXL1, ZRSR2 and TET2 [25]. Here, NRAS is linked to myelodysplastic syndrome.