Myelodysplastic syndromes (MDS) were first presented as a separate entity in hematology in 1982 by the French-American-British (FAB) group. Although widely accepted, this classification was revised in 2001 and again in 2008 by the World Health Organization (WHO). During that time, a great effort was made by diagnostic entities of world renown as well as by other research groups and individuals to establish a reliable prognostic system. Today, two systems are accepted by the hematologic community: the International World Prognostic Scoring System (IPSS) and the WHO Prognostic Scoring System (WPSS). Almost from the beginning, it was assumed that MDS are clonal disorders. Cytogenetics not only proved the clonality in the majority of cases but also greatly contributed to the stratification of patients into risk categories. With the progress made in treatment for MDS, comorbidities became an important part of the integral pretreatment consideration, as patients with a high index of comorbidity evaluation very often do not benefit from treatment. Recent advances in the diagnostic and prognostic evaluation of MDS patients were achieved by studying the effect of age in different MDS subgroups and the role of molecular markers in predicting clinical evolution.