A Trial Testing Early vs Late Onset of EPO Alfa Treatment in Lower Risk MDS

Inclusion Criteria: 1. Age ≥ 18 years 2. MDS according to WHO 2016 criteria, with low or int 1 classical IPSS 3. Non-RBC transfusion dependent anemia 4. Hb level between 9 and 10.5g/dl (at the center's lab) 5. Hb level should be at least 1g/dl higher than the Hb threshold chosen to start RBC transfusions based on age, comorbidities and predicted clinical tolerance of anemia (this transfusion threshold should be chosen between 8 and 9g/dl) 6. Serum EPO level \<500U/l 7. No other cause of anemia (including iron deficiency, vitamin B12 or B9 deficiency, hemolysis, hypothyroidism….) 8. Performance status \<=2 Exclusion Criteria: 1. Higher risk MDS (IPSS intermediate-2 or high) 2. Del 5q 3. Baseline Hemoglobin level \> 10.5 g/dl or \<9g/dl 4. Transfusion threshold (based on age , comorbidities…) \>9g/dl 5. Transfusion threshold less than 1 g/dl below baseline Hb level 6. RBC transfusion dependence. Patients may have received only one transfusion series for MDS prior to inclusion 7. CMML , if \>10 % BM blasts or WBC\>13.000/mm3 8. Uncontrolled hypertension 9. Uncontrolled cardiovascular disease including angina pectoris or cardiac failure 10. Renal failure: Creatinine clearance\<40ml/min (using MDRD formula) 11. Pregnancy (positive bettaHCG) or nursing