Bone marrow microenvironment reprogramming in myelodysplastic neoplasms: from pathological mechanisms to targeted therapeutic strategies

Myelodysplastic Neoplasms (MDS) are a group of clonal hematopoietic malignancies originating from hematopoietic stem cells. Their pathogenesis involves not only genetic abnormalities in hematopoietic cells but is also closely associated with functional dysregulation of the bone marrow microenvironment (BMME). In MDS, both the heterogeneous cellular populations and non-cellular components of the BMME exhibit significant dysfunction. Aberrant BMME components drive the initiation and progression of the disease through complex intercellular interactions. In-depth research into its pathological features and molecular mechanisms is of great significance for developing effective targeted therapeutic strategies. In recent years, novel treatment strategies based on BMME regulation have made significant progress, including immunomodulators, epigenetic regulators, molecularly targeted drugs, and cell therapies, providing new insights for improving the clinical outcomes of MDS patients. This article systematically reviews the pathological features of the BMME in MDS and its key molecular mechanisms in disease development, and discusses the latest clinical research advances in BMME-targeted therapies.