The effective treatment methods of myelodysplastic syndromes (MDS) are limited. The patient's treatment plan is mainly based on individual differences and different risk levels [by revised International Prognostic Points System (IPSS-R)], including observation, erythropoiesis stimulating agents, iron elimination, immunosuppressive agents, lenalidomide, hypomethylating agents and hematopoietic stem cell transplantation (HSCT). The limitations of the treatment strategies are important exploration directions for future clinical trials. At present, multiple clinical trials for the treatment of MDS are underway, but it is still necessary to optimize therapies through integrating molecular and genetic data and applying them to clinical practice. This article reviews the current treatment approaches of MDS and looks forward to future research directions.