With the the field of molecular diagnostics rapidly advancing, the demand for prognostic and diagnostic molecular information on myelodysplastic syndrome (MDS) is also increasing. Here, Torsten Haferlach, MD, PhD, of the Munich Leukaemia laboratory, Munich, Germany, speaks from the 2018 Society of Hematologic Oncology (SOHO) in Houston, TX, highlighting this issue. Prof. Haferlach uses examples of cases to stress the necessity for carrying out in-depth molecular background studies on patients with MDS using sequencing techniques such as next-generation sequencing (NGS), as opposed to the traditional chromosome banding method of diagnosis, to find the best treatment option for an MDS patient. Haferlach further describes the high variation in molecular profiles and variant allele frequencies for different patients with MDS, due to variable expressivity, and this results in the need for individual molecular background information for the specific diagnosis and treatment of MDS.