Transfusion Effects in Myelodysplastic Patients: Limiting Exposure

Inclusion Criteria: * diagnosis myelodysplastic syndrome (primary or secondary) based on cytopenia in at least 1 cell line + dysplasia in 2 cell lines (and no other cause (especially deficiencies)) and a pathologic anatomic diagnosis after bone marrow punction. * refractory anaemia (RA): blood: ≤ 1% blasts, ≤ 1 x 109 monocytes; bone marrow: \< 5% blasts, ringed sideroblasts ≤ 15% of the erythroid cells * refractory anaemia with ringed sideroblasts (RARS): blood: ≤ 1% blasts, ≤ 1 x 109 monocytes; bone marrow: \< 5% blasts, ringed sideroblasts \> 15% of the erythroid cells * refractory anaemia with excess blasts (RAEB): blood: \< 5% blasts, ≤ 1 x 109 monocytes; bone marrow: blasts ≥ 5 -≤ 20% * chronic myelomonocytic leukaemia (CMML): blood: \>1 x 109/l monocytes, \<5% blasts; bone marrow: blasts \< 20%, increase of the monocytic component * erythrocyte transfusion need * working knowledge of the national language * written consent for participating this study (informed consent) Exclusion Criteria: * candidate for bone marrow- or organ transplantation * medication: growth factors (GM-CSF), or EPO * patients who will receive an intensive chemotherapeutic treatment with a cytopenia, expected longer than 2 weeks * refractory anaemia with excess blasts in transformation (RAEB-t): blood: ≥ 5% blasts or Auer rods; bone marrow: or blasts \> 20 - \< 30% or Auer rods * pregnancy at the moment of inclusion * patients with congenital severe haemolytic anaemia, like thalassemia or sickle cell anaemia * patients with AIDS or a severe congenital or acquired (e.g. iatrogenic) immunological disorder * severe active infections at the moment of inclusion * severe cardiac, pulmonal, neurological, metabolic or psychiatric disease at the moment of inclusion