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Recent trials have provided important insights into managing anemia in patients with lower-risk myelodysplastic syndromes (MDS). The phase 3 EPO-Protar trial highlighted how the timing of erythropoiesis-stimulating agent (ESA) administration impacted transfusion dependence. Specifically, patients receiving ESA early, within six months of diagnosis, demonstrated a longer time to transfusion dependence compared to those treated later. Furthermore, the early ESA group had a higher erythroid response rate of 79%, suggesting that early intervention is more effective, although this did not translate to improved quality of life scores.