David Sallman, MD, of the Moffitt Cancer Center, Tampa, FL, explains the role of the immune system and inflammatory signaling in the pathogenesis of myelodysplastic syndromes (MDS), including the various mechanisms of inflammasome activation such via underlying somatic mutations, as well as the bone marrow microenvironment. Oxidized mitochondrial DNA and ASC specks, components of the inflammasome activation pathway, are useful markers for MDS reducing diagnostic uncertainty. Dr Sallman also talks on the role of NLRP inflammasome in driving MDS phenotype and sheds light on clinical trials on canakinumab, an IL-1β inhibitor specifically targeting activators of the NLRP inflammasome. This interview took place during the ninth annual meeting of the Society of Hematologic Oncology (SOHO 2021) congress.