Would you still recommend bone marrow biopsy in an elderly non-transplant eligible patient with mild cytopenias if NGS from peripheral blood indicates MDS mutations?   

Yes. The presence of mutations in peripheral blood is not diagnostic of MDS. The elderly can have CHIP mutations and mild cytopenias which qualify for CCUS rather than MDS. CCUS has a higher risk for progression to MDS but is not MDS by itself. Would get a bone marrow prior to diagnosing MDS and sta...