Shahram Kordasti, MD, PhD, King’s College London, London, UK, discusses the core biology of myelodysplastic syndromes (MDS), highlighting the impact of somatic mutations and the microenvironment on disease outcomes. In addition to this, Dr Kordasti outlines the impact of chronic inflammation, detailing how activation of the inflammasome pathway contributes to the expansion of malignant clones and genomic instability. This interview took place during the 2021 European School of Hematology (ESH) 7th Translational Research E-Conference on Myelodysplastic Syndromes.