In recent years, many experts at home and abroad have conducted numerous etiological studies on myelodysplastic syndromes (MDS) and identified a number of factors as the cause of MDS, but no conclusive conclusion has been reached so far on whether smoking promotes the development of MDS. Through our team’s research, we have identified a dose-dependent relationship between smoking and the development of MDS. Through extensive research, we have come to the following important conclusions: 1. smokers have a 45% higher risk of developing MDS than non-smokers; 2. smokers in Europe and the Americas have a higher risk of developing MDS than smokers in Asia; 3. female smokers have a higher risk of developing MDS than male smokers; 4. people who smoke more and for a longer period of time have a higher risk of developing MDS than those who smoke less and for a shorter period of time; 5. 5. The risk of developing MDS decreases in people who have quit smoking for more than 1 year. From our data, we can see that smoking is a clear causative factor in the development of MDS, and the main reasons for its induction can be summarized as follows: 1. Cigarettes contain a wide variety of harmful chemicals, such as: benzene, tobacco tar, chromium, formaldehyde, etc., which are carcinogenic to humans and have a certain induction effect on the development of MDS; 2. Smoking can reduce various immunoglobulins and immune cells in the human body 2. smoking can reduce various immunoglobulins and immune cells in the human body, thus destroying the body’s adaptive and intrinsic immune systems, and immunodeficiency is one of the important factors in the development of MDS; 3. smoking can inhibit apoptosis induced by the Fas pathway, increase NF-κB and various inflammatory factor activities, and these factors play an important role in the development of MDS. In conclusion, the findings have shown that smoking is an important predisposing factor for the development of MDS and that this predisposing effect is a dose-dependent pattern, i.e., the more and longer one smokes the higher the risk of developing MDS. In contrast, for those who already have the disease, quitting smoking helps in the treatment of the disease and facilitates a better quality of life. Therefore, from a hematological point of view, we recommend that people all over the world should eliminate smoking as a harmful habit.