The Rising Era of Immune Checkpoint Inhibitors in Myelodysplastic Syndromes

Myelodysplastic syndromes(MDS) are a heterogeneous group of diseases characterized by ineffective hematopoiesis and a wide spectrum of manifestations ranging from indolent and asymptomatic cytopeniasto acute myeloid leukemia (AML). MDS result from genetic and epigenetic derangements in clonal cells and their surrounding microenvironments. Studies have shown associations between MDS and other autoimmune diseases. Several immune mechanisms have been identified in MDS, suggesting that immune dysregulationmight be at least partially implicated in its pathogenesis. This has led to rigorous investigations on the role of immunomodulatory drugsas potential treatment options. Epigenetic modification via immune check point inhibition, while well established as a treatment method for advanced solid tumors, is a new approach being considered in hematologic malignanciesincluding high risk MDS. Several trials are looking at the efficacy of these agents in MDS, as frontline therapy and in relapse, both as monotherapy and in combination with other drugs. In this review, we explore the utility of immune checkpointinhibitors in MDS and current research evaluating their efficacy.