Despite the presence in the doctor’s arsenal of tools that can determine the risk of the course of myelodysplastic syndromes and predict the volume of examination and treatment of the patient, the ability of the disease to transform into acute myeloid leukemia at lightning speed requires the medical worker to quickly make a decision on changing the treatment strategy. The presented clinical case clearly demonstrates that, despite the rapid change in therapy, the prognosis for such patients is poorly predicted.