In lower-risk MDS patients with symptomatic anemia the first-line treatment option is erythropoiesis-stimulating agents (ESAs), namely recombinant human erythropoietins (rHuEPOs), alone or combined with granulocyte colony-stimulating factor (G-CSF), which could prevent or delay transfusion dependency and improve quality of life. This evidence concerns the gene EPO and myelodysplastic syndrome.