<p>Immunotherapy has revolutionized cancer treatments, yet checkpoint inhibitors and CAR-T cells have shown limited efficacy in acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). This limited efficacy is primarily due to the absence of lineage-specific antigens and the presence of suppressive microenvironments. Innate immunity offers a promising alternative, as it acts independently of neoantigens. The key players such as macrophages, dendritic cells, and natural killer (NK) cells not only eliminate malignant cells but also remodel the microenvironment to enhance antileukemic activity. This review highlights recent advances in understanding innate immune mechanisms in AML and MDS and explores therapeutic strategies designed to leverage these pathways, aiming to broaden the scope of immunotherapy.</p>