Background: Research on MDS is particularly sparse in the Middle East and North African (MENA) regions, with Upper Egypt representing a distinct area in terms of geography, climate, socio-demographics, and historical dualism of traditions and cultures. This study is the first to comprehensively assess the demographic, clinical, and hematologic characteristics of MDS in Upper Egypt, evaluating the disease's burden on patients.

Methods: Our study included 91 de novo MDS patients from Sohag and Assiut university hospitals, from June 2017 to January 2021. All patients subjected to history taking and clinical, hematological and bone marrow assessment, iron studies and sideroblastic anemia, cytogenetic, molecular analysis.

Results: The mean age was 54.63 years, with female predominance (57.1%). Clinically, the most prevalent complaints were anemia (41.8%) and fever (24.2%). On examination, 72.5% presented with pallor, and 45.1% had purpura, while organomegaly varied with 41.8% having no organomegaly. The study identified MDS-MLD as the most common subtype (50.5%) and normocytic normochromic as the predominant anemia type (56%). In terms of treatment, 52.7% received supportive care, and the complete response rate was 2.2%. Correlation analysis showed age and ECOG performance status positively related to bone marrow blast percentage, and overall survival had a moderate positive correlation (r = .502) with progression-free survival.

Conclusion: This study indicates that MDS predominantly affect middle-aged adults in Upper Egypt, predominantly females, with varied clinical presentations and a predominance of low-risk patients according to IPSS-R, suggesting a better prognosis. Normal cytogenetics were prevalent, and MDS-MLD was the most common classification.