Randomised controlled trials have supported the European approval of epoetin alfa for treating symptomatic anaemia in adults with low or intermediate-1 risk primary MDS [4,6], specifically for patients with serum erythropoietin (EPO) levels below <200 IU/L and haemoglobin (Hb) levels ≤100 g/L. This evidence concerns the gene GSTM1 and myelodysplastic syndrome.