Global research trends in myelodysplastic syndromes drug resistance: A comprehensive bibliometric and knowledge mapping study

Background Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal hematopoietic stem cell disorders that frequently evolve into acute myeloid leukemia (AML). Despite advances in supportive care and targeted treatments, therapy resistance, especially to hypomethylating agents, remains a significant clinical challenge that compromises long‑term patient survival. In recent years, a growing body of literature has emerged addressing the molecular and cellular basis of resistance, highlighting the role of genomic and epigenetic alterations, as well as the therapeutic promise of precision medicine. Methods A comprehensive literature search was conducted in the Web of Science Core Collection database for studies published between 2005 and 2025, focusing on drug resistance in MDS. Bibliometric analyses were performed using CiteSpace to assess annual publication trends, international collaborations, influential institutions and authors, journal co‑citations, and keyword clustering, thereby capturing the knowledge structure and emerging hotspots in the field. Results A total of 789 eligible articles were identified, revealing a growing trend in research output over the study period. The United States emerged as the central node with the highest collaboration strength, followed closely by China and Germany. Leading institutions, such as the University of Texas System, UTMD Anderson Cancer Center, and Harvard University, shaped the global collaborative network. Influential authors (e.g., Kantarjian H, Garcia‑Manero G, and Fenaux P) and foundational studies defined the intellectual structure of the field. Thematic analyses identified key clusters centered on genomic mutations (TP53, ASXL1, DNMT3A), epigenetic treatments (azacitidine, decitabine), and targeted therapy (BCL‑2, IDH1/2). The evolution of keywords over time reflected a shift from early focus areas like disease pathogenesis and bulk disease resistance towards precision medicine, cellular biology, and targeted therapeutic interventions for therapy‑resistant MDS. Conclusions This bibliometric study provides a comprehensive and systematic mapping of the evolving research landscape of therapy resistance in MDS, highlighting critical hotspots, influential authors, and collaborative patterns. The findings underscore a paradigm shift towards precision medicine, where long‑term disease control will hinge on understanding and targeting the cellular and molecular drivers of resistance. By identifying these trends and knowledge gaps, this study aims to guide future research priorities and clinical strategies for improved patient outcomes in MDS.