Theo de Witte, MD, Radboud University Medical Center, Nijmegen, The Netherlands, discusses the pathology of myelodysplastic syndromes (MDS) and how our understanding has expanded since the molecular era. The issue of comorbidities in MDS patients is also outlined. This interview took place at the 2nd Regional Symposium on Myelodysplastic Syndromes (MDS 2020), held in Tel Aviv, Israel.