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Indeed, low PLT and Hb levels, along with malignant clone carrying poor cytogenetic aberrations are more accurate predictors for infection risk than neutropenia. This is consistent with the recent report suggesting that nearly all BM cells in patients with MDS and secondary AML are clonally derived [24]. Surprisingly, BM blast percentage did not correlate with infectious events. Infections were more prevalent among AML patients (blasts > 20%) than in MDS patients with blast counts lower than 5%; yet, this difference did not reach statistical significance (19.2% vs. 12.1%, P = 0.12). In addition, higher rates of infection were observed among patients with 5�C10% of blasts compared to those presenting with 10�C20% of blasts (21.3% vs. http://www.selleckchem.com/products/epacadostat-incb024360.html 14.8%, P = 0.03). In our analysis, blast count recorded prior to therapy was applied to all consecutive cycles prescribed to a patient. As the number of blasts in the BM has not been followed during therapy, real data about the actual blast number during each cycle are missing. Recently, a revised version of the IPSS score taking into account patient's transfusion dependency has been proposed [25]. Transfusion dependency is defined as administration of more than two red pack-cells a month for two consecutive months. In the current study, 145 cycles of therapy were given to the patients who did not have a 2-month delay between MDS diagnosis and the first AZA dose. With the increased availability of http://www.selleckchem.com/products/i-bet-762.html AZA, smaller numbers of patients will have their therapy delayed and hence, stratifying patients upon the present definition of transfusion dependency will become less practical. A recent Dutch retrospective survey of 90 MDS/AML patients, who were treated with AZA, identified the absence of circulating blasts, standard and good cytogenetics and an increase in PLT count following the first AZA dose http://www.selleck.cn/products/lee011.html of more than twofolds as independent predictors for response and survival [26]. This is the other side of the same coin, cytogenetics and PLT counts represent BM potential for better (response) or for worse (infection). This is a large retrospective series, and some practical conclusions may be drawn from it. The presence of at least one of the three identified risk factors (unfavorable cytogenetics, low Hb or PLT) prior to AZA administration, indicates cycles with higher infection risk. Such stratification allowed coverage of 82% (126/153) infectious events; however, this high sensitivity came at a price of a need to classify 659/928 (71%) cycles as high risk for infection (specificity of 31%). Five hundred forty five AZA cycles (58.8%) were administered while Hb was