According to these guidelines and to the European approval, ESA therapy is suggested for MDS patients who meet the following criteria: symptomatic anaemia, Hb levels <10 g/dL, low to intermediate‐1 IPSS6 or very low‐ to intermediate‐risk IPSS‐R,7 <2 RBC units per month and/or serum EPO (sEPO) levels <500 iu/L (noting that the European Medicines Agency [EMA]‐approved indication for epoetin alpha specifies the need for sEPO level of <200 iu/L). This evidence concerns the gene EPO and myelodysplastic syndrome.