Approximately 30% of patients with myelodysplastic syndromes (MDS) progress to secondary acute myeloid leukemia (sAML). Whilst the mechanisms underlying this event are becoming clearer, it remains a difficult disease to treat. In this video, Daniel Wiseman, MBChB, MRCP, FRCPath, PhD, University of Manchester, Manchester, UK, outlines management strategies for patients with sAML from MDS. The introduction of CPX-351 has significantly improved patient outcomes. However, this combination is not suitable for many older patients due to its toxicity. The combination of venetoclax and azacitidine has shown promising responses in older patients with sAML with prior exposure to hypomethylating agents. This interview took place at the 62nd Annual Scientific Meeting of the British Society for Haematology (BSH) 2022, in Manchester, UK.