Therapeutic algorithm in LR-MDS patients. Therapeutic options for symptomatic low-risk MDS patients showing anemia or thrombocytopenia. Approximately 80% of eligible patients have EPO levels <200 IU/L, whereas only ∼10% have levels >500 IU/L.¹⁵  As a result, ∼90% of LR-MDS patients with anemia are eligible to receive ESAs according to current guidelines. Only 10% to 20% of patients with EPO levels >500 IU/L are unlikely to respond to ESAs and should therefore receive alternative approaches. Notably, prescribing information of the only approved ESA (Eprex) in the EU and United States requires EPO levels <200 IU/L before treatment. At all stages, the patient should be evaluated for a potential clinical trial option. Luspatercept may become a second-line option in the near future in RS⁺ patients. Thrombopoiesis-stimulating agents are a potential first-line option in patients with clinically meaningful thrombocytopenia. In the presence of TP53-mutation in del(5q), MDS patients should be followed an intensified disease surveillance strategy to detect early signs of disease progression. Dotted arrows indicate potential option in the absence of any therapeutic alternatives. G-CSF, granulocyte colony-stimulating factor; ATG, antithymocyte globulin; CSA, cyclosporine; HMA, hypomethylating agent; LEN, lenalidomide; LUSP, luspatercept; sEPO, serum EPO; TPO-RA, thrombopoietin receptor agonist. *Not presently approved. †Intensified disease surveillance.