A multicenter study reported that DNA methylation patterns at diagnosis can predict which myelodysplastic syndrome patients will respond to azacitidine, pointing to a potential precision-care strategy. The findings position epigenomic readouts as candidate companion biomarkers for treatment selection rather than relying solely on clinical risk categories. If validated prospectively, methylation-driven stratification could help reduce trial-and-error treatment decisions in MDS, where response variability remains a key clinical challenge.