Fig. 5: The pattern of ineffective erythropoiesis in MDS patients.

A spectrum of somatic mutations occurs in partial HSCs, generating the malignant clone. With the accumulation of genetic lesions in HSPCs during their lifespan, usually accompanied by alterations of BM niche, the disorders of erythropoiesis, including differentiation arrest, precocity and premature aging of erythroid cells and increased apoptosis of erythroid precursors, aggravate gradually and eventually lead to ineffective erythropoiesis and a remarkable decrease in ARC and RBCs in peripheral blood.