Myelodysplastic syndromes (MDS) are oligo-clonal diseases of the hematopoietic stem cell compartment resulting in peripheral cytopenias and a tendency of developing acute myeloid leukemia (AML). MDS show an incidence of approximately 4/100.000/year. However, MDS are mainly a disease of the elderly with a sharp increase in incidence in the age decade above 70 years. Due to the demographic change in western countries, it is expected that the MDS will play an increasing role for these health systems. Although anemia is the predominant cytopenia in the majority of patients, about 30-50% of patients suffer from neutropenia of varying severity. Risk assessment was initially done based on the particular subtypes within the FAB classification1 . The international prognostic scoring system (IPSS) was the first to include - beside medullary blast count and karyotype - the number of cytopenias and thereby indirectly taking the neutrophil count into consideration2 . Finally, in 2012 the revised IPSS included the severity of neutropenia into risk stratification3 .