The International MDS Risk Analysis Workshop recently developed a consensus risk-based International Prognostic Score System (IPSS) for primary MDS, which has markedly improved prognostic stratification of MDS patients. Following IPSS,it is now possible to identify patients (i.e. Hig-Risk and Intermediate-2-Risk patients) with a bad prognosis (i.e. a life-expectancy < 1 year) due to a high risk of leukemic evolution.