Study at MD Anderson Cancer Center (IRB-approved, ClinicalTrials.gov NCT04239157) enrolled patients with relapsed/refractory lower-risk MDS (IPSS/IPSS-R ≤3.5, hemoglobin <10 g/dL, symptomatic anemia/transfusion dependency). Open-label, single-arm, phase 2 trial used canakinumab (150 mg, then 300 mg subcutaneously) with primary endpoint of hematologic improvement (HI). Secondary objectives included safety, transfusion independence, duration of response, progression-free survival, leukemia-free survival, and overall survival. Bone marrow assessments, single-cell RNA sequencing, and cytokine/chemokine quantification were performed. Statistical analyses used modified IWG 2006 criteria, Kaplan–Meier method, Cox proportional hazards model, and R platform.