Presence of myeloproliferative and myelodysplastic features in MPN. (A-C) The 3 MPN-restricted drivers lead to a myeloproliferative phenotype. All of the additional mutations in genes involved in epigenetics and splicing modify the differentiation and give a myelodysplastic phenotype even if some of them such as TET2, DNMT3A, and EZH2 clearly play an important role in initiation. Moreover, there are additional mutations involved in splicing that induce myelodysplastic features leading to MF, cytopenia, and eventually progression to leukemia. Professional illustration by Somersault18:24.