Signs that MDS has progressed to AML

Table of Contents 

• Introduction
• Understanding MDS and AML
• Risk factors for progression from MDS to AML
• Signs and symptoms indicating progression
• Diagnostic criteria for AML transformation
• Prognosis after progression
• Treatment options post-progression
• Monitoring and follow-up care
• FAQs
• Blood Cancer United research impact
• Conclusion
• References

Key Takeaways 

• Myelodysplastic syndromes (MDS) are a group of blood cancers that increase the risk of developing acute myeloid leukemia (AML), especially in people over 65. 
• AML is a more aggressive blood cancer, with rapid symptom progression and worse prognosis, especially when it develops from MDS. 
• Signs of MDS progressing to AML include worsening fatigue, infections, bruising, bleeding, bone pain, and abnormal blood counts. 
• Treatment options include intensive chemotherapy, targeted therapies, stem cell transplantation, and participation in clinical trials for emerging therapies. 
• Ongoing monitoring, supportive care, and psychosocial support are essential for managing MDS and AML. 
• While preventing progression from MDS to AML is not always possible, maintaining overall health and tailoring treatments may help delay progression. 

If you or someone you love lives with myelodysplastic syndromes (MDS), you already know how much this diagnosis changes daily life. Worrying about whether the disease might be getting worse—or turning into something more serious—is completely understandable. 

Blood Cancer United understands this concern, and we’re here to help you recognize the signs that MDS may be progressing to acute myeloid leukemia (AML). That way, you and your care team can act quickly and feel more prepared for whatever comes next.

Understanding MDS and AML

MDS is a group of blood cancers that start in the bone marrow—the part of your body that makes blood cells. When the bone marrow doesn't work the way it should, it can't produce enough healthy blood cells. Living with MDS means paying close attention to how you feel and staying in close contact with your care team, so that concerns can be addressed as quickly as possible (Dotson, 2022). 

Risk factors include: 

• Certain chemicals 
• Family history of MDS 
• Aging 
• Previous chemotherapy or radiation therapy 

MDS most often presents in people over age 65. It is also more common in males and people of Caucasian descent. 

MDS has the potential to progress to acute myeloid leukemia (AML), a more aggressive form of blood cancer. One of the primary differences between AML and MDS is severity and rapid progression. Symptoms can get worse quickly, which is why diagnosing it early makes such a difference (Vakiti, 2024). AML typically requires more urgent treatment because of its aggressive nature. 

AML has several subtypes, which can be classified based on the specific gene mutations (Arber, 2022): 

• Acute promyelocytic leukemia (APL) is the most treatable subtype of AML. It typically contains the t(15; 17) translocation. 
• AML with NPM1 or CEBPA mutations
• AML with FLT3 or TP53 mutations

Knowing the specific subtype of AML can guide treatment and prognosis.

Risk factors for progression from MDS to AML

Many things can affect the progression of MDS to AML. These include certain gene changes, chromosomal problems, past treatments, previously going through chemotherapy or radiation, and the number of immature cancer cells, known as MDS blast cells. 

Certain gene changes can make it more likely that MDS will turn into AML. Your doctor will watch for these in your test results. You don't need to understand every mutation, but it helps to know that this is something your care team actively monitors. 

Some of the genes that make it more likely for MDS to progress to AML include (Menssen, 2022): 

• TP53 
• RUNX1 
• ASXL1 
• FLT3 
• NRAS< 
• IDH1/2

Certain chromosomal changes, like missing or extra pieces of chromosomes 5, 7, or 8, also raise the risk. Having more than one mutation increases the chance of progression (Hosono, 2019). 

Blasts are immature blood cells that normally develop in the bone marrow and mature into healthy red blood cells, white blood cells, and platelets. Having some blasts in the bone marrow is normal and necessary because they are the source of new blood cells. However, in MDS and AML, abnormal blast cells can accumulate and take up too much space in the bone marrow. 

When these abnormal blasts make up 20% or more of the bone marrow, MDS has most likely progressed to AML (Döhner et al., 2022). At this point, the abnormal cells crowd out healthy blood-forming cells, reducing the body's ability to produce normal blood cells and leading to symptoms such as fatigue, infections, bruising, and bleeding.

Signs and symptoms indicating progression

Watch for sudden changes or worsening symptoms, as these may mean that MDS is turning into AML. Signs to look for include: 

• Increasing fatigue 
• More frequent or more severe infections 
• Increased bruising or bleeding 
• Worsening blood counts 
• Bone pain 
• Unexplained fevers 

If you have MDS and notice these symptoms, contact your doctor right away. 

Lab tests are one way to know if MDS is turning into AML. They will often show that more blasts are in the blood or the bone marrow.

Diagnostic criteria for AML transformation

Doctors diagnose AML mainly by looking at the percentage of blasts in the bone marrow. If blasts make up 20% or more, this usually means AML (Dohner, 2022). Worsening blood counts, such as anemia (low red blood cells), leukopenia (low white blood cells), or thrombocytopenia (low platelets), may also indicate AML. 

Some chromosomal abnormalities may indicate AML regardless of the blast percentage. If AML is suspected, healthcare providers may perform additional testing to confirm the diagnosis. These can include: 

• Immunophenotyping, which identifies proteins on the surface of cells
• Cytogenetic analysis, which examines chromosomes for abnormalities 
• Molecular testing, which looks for genetic mutations associated with AML 

AML requires more urgent and intensive treatment compared to MDS, so it is important to identify AML transformation quickly.

Prognosis after progression

When MDS turns into AML, the outlook can be serious—and it's natural to feel frightened by that. Survival varies from person to person and depends on many factors. 

Younger people and those in good overall health tend to respond better to treatment. Genetic changes in blood-forming cells can also affect outlook. Some mutations, such as TP53, ASXL1, and RUNX1, are associated with a higher risk of progression and a less favorable prognosis. 

Your doctor can help you understand what your genetic testing results mean for your specific situation and what treatment options are available (Wang, 2025). 

How well you respond to treatment also affects your outlook. People who respond well to chemotherapy or targeted therapy are more likely to go into remission and live longer. If treatment does not work well, especially after previous therapies or with complex gene changes, the disease may progress faster, and options may be limited. 

However, advances in AML research continue to expand the range of available treatments and improve outcomes for many patients. Researchers are regularly developing and testing new targeted therapies, immunotherapies, and combination treatment approaches.

Organizations like Blood Cancer United help support and fund research aimed at improving the prevention, diagnosis, and treatment of AML. To learn more about current research and emerging therapies, visit Blood Cancer United's AML research library.

Treatment options post-progression

There are several options for treating AML, including after progression from MDS (Dohner, 2022). 

Chemotherapy 

For patients whose MDS has progressed to AML, doctors may use intensive chemotherapy. These treatments are similar to those used for people who get AML without MDS. If you cannot have strong chemotherapy, your doctor may use hypomethylating agents (HMAs) instead, or as a step before a stem cell transplant (Bewersdorf, 2020). 

Targeted therapies 

Targeted therapies work against specific genetic mutations or proteins that help AML cells grow and survive. By blocking these abnormal pathways, targeted therapies can slow the growth of leukemia cells or cause them to die while minimizing damage to healthy cells. 

Examples include (Turkalj, 2023): 

• FLT3 inhibitors, such as gilteritinib 
• IDH1/2 inhibitors such as ivosidenib and enasidenib 
• BCL-2 inhibitors such as venetoclax 
• CD33-targeted therapies such as gemtuzumab ozogamicin 

Stem cell transplants 

An allogeneic stem cell transplant is another treatment option for AML. This is the only treatment that can cure some people, especially if the disease comes back or does not respond to other therapies. Not everyone can have a transplant, as age, other health problems, and finding a donor are important factors in determining if this treatment is a viable option (Loke, 2021). 

Clinical trials and emerging therapies 

If you learn that your MDS has progressed to AML, it is important to discuss all available treatment options with your healthcare team, including clinical trials. Clinical trials evaluate new therapies and treatment combinations that may not yet be widely available. 

For some patients, especially those with high-risk disease, relapsed AML, or genetic mutations that make standard treatments less effective, a clinical trial may provide access to promising new therapies. 

Researchers continue to develop and test new approaches for treating AML. Emerging therapies include immunotherapies such as monoclonal antibodies, bispecific T-cell engagers (BiTEs), and chimeric antigen receptor (CAR) T-cell therapies. Scientists are also studying new targeted therapies and combinations of existing treatments to improve outcomes for people with AML (Davis, 2018). 

Finding and evaluating clinical trial options can be overwhelming. Blood Cancer United's Clinical Trial Nurse Navigators help patients and caregivers navigate the clinical trial process, understand eligibility requirements, and identify potential trial opportunities. 

As research advances, clinical trials remain an important part of expanding treatment options and improving outcomes for people living with AML.

Monitoring and follow-up care

Regular monitoring and follow-up are key for people with MDS or AML. This usually means seeing your doctor for exams, blood tests, and possibly bone marrow biopsies. Your care team will also watch for side effects, infections, and other problems. 

Your follow-up plan should fit your individual needs. Supportive care helps manage symptoms, prevent infections, and keep you as healthy as possible. Emotional and social support are also important—and, if you would like support from others who understand what you are going through, Blood Cancer United has resources that can help.

FAQs

What factors affect the risk of MDS progressing to AML? 

The risk of MDS progressing to AML depends on whether the disease is classified as high-risk or low-risk. People with high-risk MDS are much more likely to develop AML and often do so sooner than those with low-risk MDS. High-risk MDS is characterized by factors such as higher blast counts, certain genetic mutations, abnormal chromosomes, and more severe blood count abnormalities. In contrast, low-risk MDS may remain stable for many years and is less likely to progress to AML. 

Overall, about 30% to 40% of people with MDS will eventually develop AML (Wang, 2025). 

Can progression from MDS to AML be prevented? 

You may not be able to fully prevent MDS from turning into AML, but it may be possible to slow it down. Staying as healthy as possible and following your treatment plan can help lower your risk (Zhang, 2026).

Blood Cancer United research impact

Blood Cancer United supports hundreds of research projects to improve treatments for blood cancers like MDS and AML. These projects have already led to important advances. The goal is to find cures for all types of MDS and AML.

To support MDS and AML research, as well as research into other kinds of blood cancer, please consider donating today. 

Conclusion

MDS carries a significant risk of progression to AML. This progression remains a clinical challenge. Early recognition of progression and prompt evaluation are vital for effective management. Treatment strategies continue to evolve to improve outcomes. 

If you have MDS, it is important to attend regular follow-up appointments. Changes in symptoms, blood counts, or bone marrow findings may signal disease progression and warrant further evaluation. 

While a diagnosis of AML can be overwhelming, advances in targeted therapies, stem cell transplantation, immunotherapies, and clinical trials continue to expand treatment options. 

Ongoing research is improving our understanding of both MDS and AML, offering new hope for patients and families affected by these conditions.

References

1. Dotson, Jennifer L., and Yehuda Lebowicz. 2022. “Myelodysplastic Syndrome.” StatPearls - NCBI Bookshelf. July 18, 2022. https://www.ncbi.nlm.nih.gov/books/NBK534126/. 
2. Vakiti, Anusha, Samuel B. Reynolds, and Prerna Mewawalla. 2024. “Acute Myeloid Leukemia.” StatPearls - NCBI Bookshelf. April 27, 2024. https://www.ncbi.nlm.nih.gov/books/NBK507875/. 
3. Arber, Daniel A., Attilio Orazi, Robert P. Hasserjian, Michael J. Borowitz, Katherine R. Calvo, Hans-Michael Kvasnicka, Sa A. Wang, et al. 2022. “International Consensus Classification of Myeloid Neoplasms and Acute Leukemias: Integrating Morphologic, Clinical, and Genomic Data.” Blood 140 (11): 1200–1228. https://doi.org/10.1182/blood.2022015850. 
4. Döhner, Hartmut, Andrew H. Wei, Frederick R. Appelbaum, Charles Craddock, Courtney D. DiNardo, Hervé Dombret, Benjamin L. Ebert, et al. 2022. “Diagnosis and Management of AML in Adults: 2022 Recommendations From an International Expert Panel on Behalf of the ELN.” Blood 140 (12): 1345–77. https://doi.org/10.1182/blood.2022016867. 
5. Hasserjian, Robert P. 2022. “The Seeds of Progression From Myelodysplastic Syndrome to Acute Myeloid Leukemia Are Sown Early in the Course of Disease.” The Hematologist 19 (6). https://doi.org/10.1182/hem.v19.6.202263. 
6. Hosono, Naoko. 2019. “Genetic Abnormalities and Pathophysiology of MDS.” International Journal of Clinical Oncology24 (8): 885–92. https://doi.org/10.1007/s10147-019-01462-6. 
7. Wang, Yufang, Fang Hu, and Jinyong Ke. 2025. “Prognosis of the Transformation of Myelodysplastic Syndromes to Acute Myeloid Leukemia: A Retrospective Study.” Medicine 104 (35): e43783. https://doi.org/10.1097/md.0000000000043783. 
8. Sekeres, Mikkael A. Platzbecker, U. 2024 “Myelodysplastic Syndromes/Neoplasms (MDS): Overview of Diagnosis and Management - UpToDate.” UpToDate. https://www.uptodate.com/contents/myelodysplastic-syndromes-neoplasms-mds-overview-of-diagnosis-and-management. 
9. Kantarjian, Hagop, Tapan Kadia, Courtney DiNardo, Naval Daver, Gautam Borthakur, Elias Jabbour, Guillermo Garcia-Manero, Marina Konopleva, and Farhad Ravandi. 2021. “Acute Myeloid Leukemia: Current Progress and Future Directions.” Blood Cancer Journal 11 (2): 41. https://doi.org/10.1038/s41408-021-00425-3. 
10. Bewersdorf, Jan Philipp, Hetty Carraway, and Thomas Prebet. “Emerging Treatment Options for Patients With High-risk Myelodysplastic Syndrome.” Therapeutic Advances in Hematology 11 (January 1, 2020): 2040620720955006. https://doi.org/10.1177/2040620720955006. 
11. Turkalj, Sven, Felix A. Radtke, and Paresh Vyas. “An Overview of Targeted Therapies in Acute Myeloid Leukemia.” HemaSphere 7, no. 6 (May 26, 2023): e914. https://doi.org/10.1097/hs9.0000000000000914. 
12. Loke, Justin, Richard Buka, and Charles Craddock. “Allogeneic Stem Cell Transplantation for Acute Myeloid Leukemia: Who, When, and How?” Frontiers in Immunology 12 (May 3, 2021): 659595. https://doi.org/10.3389/fimmu.2021.659595. 
13. Davis, Julian R, David J Benjamin, and Brian A Jonas. “New And Emerging Therapies for Acute Myeloid Leukaemia.” Journal of Investigative Medicine 66, no. 8 (August 20, 2018): 1088–95. https://doi.org/10.1136/jim-2018-000807. 
14. Zhang, Yucheng, Lixiang Yan, Chenyang Fan, Bofan Zhao, Meng Chen, Xiaogang Hao, Gengda Zhu, Yanan Jia, Yajing Xu, and Zhexin Shi. “Myelodysplastic Syndrome Progress to Acute Myeloid Leukemia: New Insights and Updates.” Frontiers in Immunology 17 (February 4, 2026): 1769944. https://doi.org/10.3389/fimmu.2026.1769944.