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Tosato et al. J Cancer Metastasis Treat 2021;7:52 Journal of Cancer
DOI: 10.20517/2394-4722.2021.120
Metastasis and Treatment

Review Open Access

Bone marrow niches in myelodysplastic syndromes

Giovanna Tosato, Jing-Xin Feng, Hidetaka Ohnuki, Minji Sim
Laboratory of Cellular Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.
Correspondence to: Giovanna Tosato, MD, Laboratory of Cellular Oncology, National Cancer Institute, National Institutes of
Health, 37 Convent Dr., Building 37, Bethesda, Maryland 20892, USA. E-mail: tosatog@mail.nih.gov

How to cite this article: Tosato G, Feng JX, Ohnuki H, Sim M. Bone marrow niches in myelodysplastic syndromes. J Cancer
Metastasis Treat 2021;7:52. https://dx.doi.org/10.20517/2394-4722.2021.120

Received: 18 May 2021 First Decision: 25 Jun 2021 Revised: 6 Jul 2021 Accepted: 14 Jul 2021 First online: 14 Jul 2021

Academic Editor: Lucio Miele Copy Editor: Yue-Yue Zhang Production Editor: Yue-Yue Zhang

Abstract
Genetic and epigenetic lesions within hematopoietic cell populations drive diverse hematological malignancies.
Myelodysplastic syndromes (MDS) are a group of myeloid neoplasms affecting the hematopoietic stem cells
characterized by recurrent genetic abnormalities, myelodysplasia (a pathological definition of abnormal bone
marrow structure), ineffective hematopoiesis resulting in blood cytopenia, and a propensity to evolve into acute
myelogenous leukemia. Although there is evidence that the accumulation of a set of genetic mutations is an
essential event in MDS, there is an increased appreciation of the contribution of specific microenvironments,
niches, in the pathogenesis of MDS and response to treatment. In physiologic hematopoiesis, niches are critical
functional units that maintain hematopoietic stem and progenitor cells and regulate their maturation into mature
blood cells. In MDS and other hematological malignancies, altered bone marrow niches can promote the survival
and expansion of mutant hematopoietic clones and provide a shield from therapy. In this review, we focus on our
understanding of the composition and function of hematopoietic niches and their role in the evolution of myeloid
malignancies, with an emphasis on MDS.

Keywords: Hematological malignancies, endothelial cells, stromal cells, bone marrow niches, microenvironment,
angiogenesis, inflammation, hypoxia

INTRODUCTION
Myelodysplastic syndromes (MDS) are characterized by the presence of persistent cytopenia involving one
or more hematopoietic cell lineages associated with morphologic evidence of bone marrow dysplasia

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
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