Management of higher risk myelodysplastic syndromes after hypomethylating agents failure: are we about to exit the black hole?

Advances in the understanding of the genetic and immune pathogenesis of HMA failure will lead to biomarker-driven therapeutic approaches and to an era of individualized therapeutic concepts (e.g. IDH inhibitors and APR246). The improved understanding of molecular mechanisms of pathogenesis and immune evasion are offering further opportunities for the rational design of novel agents. Efforts to optimize frontline HMA-based treatment are of paramount importance.