Mikkael Sekeres, MD, MS, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, discusses the challenges in drug development in myelodysplastic syndromes (MDS) with respect to aligning trial endpoints for lower and higher risk patients with treatment goals meaningful to patients. This interview took place at the 2nd Regional Symposium on Myelodysplastic Syndromes (MDS 2020), held in Tel Aviv, Israel.