Transcriptomic analysis revealed downregulation of inflammatory pathways (IL-2-STAT5, IL6-JAK-STAT3, interferon responses) and the p53 pathway, along with enrichment of MYC targets in the high L/M group.<h4>Conclusion</h4>An elevated L/M ratio is an independent and readily available biomarker that predicts poor outcomes in MDS. Here, TP53 is linked to myelodysplastic syndrome.