A number of steroid sparing agents have been used including anti-interleukin-1 [IL-1] inhibitors such as anakinra and canakinumab [1, 29, 33], anti-IL-6 inhibitors such as tocilizumab and siltuximab [29, 34, 35], JAK inhibitors such as ruxolitinib, tofacitinib, baricitinib, and upadacitinib [33, 36–38]and hypomethylating agents (HMA) in patients with MDS or MDS related cytogenetic mutations [10, 21, 39–41]. The gene discussed is IL6; the disease is myelodysplastic syndrome.