Myelodysplastic syndromes (MDS) remain challenging to both clinicians and biologists. This year's edition of the Annual Meeting of the American Society of Hematology has provided several breakthroughs in the biology and therapeutics of MDS, such as uncovering of the molecular genetics of the 5q- syndrome and clear evidence of a survival advantage with a hypomethylating agent in high-risk MDS. We summarize those advances and delineate some perspectives for these diseases.