The myelodysplastic syndromes (MDS) are a distinct group of clonal disorders of hematopoietic stem or progenitor cells characterized by ineffective hematopoiesis and peripheral cytopenias. The data on the epidemiology of MDS in Russia are absent.The aim of the study was to evaluate the incidence of MDS in adults, to evaluate methods of diagnosis confirmation and choice of therapy in the system of Moscow Health Care.The observational study included adult patients with newly diagnosed MDS in 2010. Two hundred and one adult patients (male - 110, female - 118) were registered. Median age at diagnosis was 71.5 years (range, 23.9-93.7). The incidence rate of MDS was 2.0 cases per 100.000 persons per year in the general adult population. All patients divided into 5 groups depending on the type of first-line therapy: 69 patients treated withepoetin alfa or beta; 20 - lowdose Ara-C; 12 - hypomethylating agents; 60 - symptomatic (red cell transfusion for low-risk MDS) and 38 - palliative care (elderly and weakened high-risk patients). Two patients with 5q- syndrome treated with lenalidomide. With a median follow-up for survivors 46 months 4-year overall survival (OS) for all patients was 34.8±13.4% (median 24.3 months). The incidence of MDS in Moscow, Russia is 1.5-2 times lower than in Europe and the United States. Current standards of survey under the mandatory health insurance does not provide for molecular and cytogenetic assays, which is one of the factors limiting the diagnostic potential.