Conclusion
In summary, we report a rare case of transformation of myelodysplastic syndrome to AMKL in a middle-aged gentleman who was refractory to induction and salvage chemotherapy. The risk factors for his poor outcome are advanced age, aggressive disease biology, underlying presence of MDS, poor response to induction chemotherapy, high lactate dehydrogenase and lack of good cytogenetic and molecular mutations. More intensive research into the molecular pathogenesis of this disease is required to achieve better therapeutic modalities as current conventional therapies are ineffective.