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The classification of myelodysplastic syndrome is a continuously evolving process. Every new validated myelodysplastic syndrome classification reflects the better understanding of the disease, its pathogenesis and outcome. The proposed classifications attempt to create more homogenous subtypes of myelodysplastic syndrome, to better predict the prognosis and outcome.The myelodysplastic syndrome classifications evolved from the French–American–British to the WHO classification over the last few years. Several new studies validate the WHO classification. The International Prognostic Scoring System is very important to define patient risk of progression to acute myeloid leukemia and predict overall survival. Recent studies suggest International Prognostic Scoring System modifications and a group proposes a new WHO-based prognostic system.The WHO and International Prognostic Scoring Systems serve as tools to categorize patients in risk groups according to which the goal and type of treatment are different. The myelodysplastic syndrome classifications will continue to be reviewed and modified as we learn more about the disease to better perform this risk stratification.