Incorporation of next-generation sequencing (NGS) into surveillance in IBMFS patients. (A) Current surveillance strategies in IBMFSs rely on serial monitoring of peripheral blood counts, bone marrow morphology, and cytogenetics. Incorporation of NGS to identify CH and assign specific mechanisms of somatic mutation may allow for early detection of clones with increased transformation risk and enable early intervention. (B) Schematic of CH in a patient with IBMFS. Distinct clones can coexist over time, with only certain transformation-associated clones at risk for evolving into MDS/AML.