Median overall survival (OS) for very low and low-risk MDS can range from 8.8 to5.3 years without therapy, and some patients may have relatively indolent diseasefor months to years without the need for therapeutic intervention.15 Thus, treatment options for lower-risk MDS are predicated on improvingsymptom burden and quality of life and delaying or preventing progressive disease.Treatment options for lower-risk MDS include erythroid stimulating agents (ESAs),thrombopoietin agonist (TPO), luspatercept, lenalidomide, immunosuppressive therapy,and hypomethylating agents (HMAs). This evidence concerns the gene THPO and myelodysplastic syndrome.