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Patients with low-risk myelodysplastic syndromes (MDS) usually develop iron overload. This leads to a high level of oxidative stress in the bone marrow (BM) and increases haematopoietic cell dysfunction. Our objective was to analyse whether chelation with deferasirox (DFX) alleviates the consequences of oxidative stress and improves BM cell functionality. We analysed 13 iron-overloaded MDS patients' samples before and 4-10 months after treatment with DFX. Using multiparametric flow cytometry analysis, we measured intracellular reactive oxygen species (ROS), DNA oxidation and double strand breaks. Haematopoietic differentiation capacity was analysed by colony-forming unit (CFU) assays. Compared to healthy donors, MDS showed a higher level of intracellular ROS and DNA oxidative damage in BM cells. DNA oxidative damage decreased following DFX treatment. Furthermore, the clonogenic assays carried out before treatment suggest an impaired haematopoietic differentiation. DFX seems to improve this capacity, as illustrated by a decreased cluster/CFU ratio, which reached values similar to controls. We conclude that BM cells from MDS are subject to higher oxidative stress conditions and show an impaired haematopoietic differentiation. These adverse features seem to be partially rectified after DFX treatment.The myelodysplastic syndromes (MDS) comprise a heterogeneous group of malignant haematopoietic stem cell disorders that result in clonal haematopoiesis. This disorder occurs with cytopenia and dysplastic features as a consequence of ineffective haematopoiesis. Clinical presentation and evolution of MDS is heterogeneous. Anaemic syndrome, increased risk of infections and haemorrhagic manifestations are often present. These clinical aspects vary depending on the predominant cytopenia in each case, with anaemia being the most prevalent (up to 80-90% of patients) and the major

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