Following this study the investigators now have the information needed to progress to a definitive trial of different red cell transfusion strategies to determine effectiveness and safety.

1. SUB-TYPE OF MDS: All MDS patients who are transfusion dependant
2. SEVERITY OF MDS: All
3. INVESTIGATIONAL INTERVENTION: Blood transfusion support
4. Aims and benefits: This is a randomised, single-blind, controlled trial comparing quality of life in patients with MDS transfused to two different haemoglobin levels.
   • Group A - Restrictive transfusion strategy
   • Group B - Liberal transfusion strategy
5. Basic inclusion criteria:
   • All patients with MDS ≥ 18 years of age and with < 20% blasts on bone marrow aspirate (including non-proliferative CMML and other MDS/MPN overlap diseases)
   • Transfusion dependent: at least 1 red cell transfusion episode per month in the last 8 weeks
   • Life expectancy >6 months
6. Basic exclusion criteria:
   • Unable, in the opinion of the attending clinician, to tolerate restrictive or liberal red cell transfusion thresholds
   • ECOG performance status ≥ 3
   • Patients being actively treated with erythropiesis stimulating agents (ESAs) or disease modifying agents for their MDS (such as lenalidomide, azacitidine, hydroxycarbamide, experimental agents)
   • Patients with myelofibrosis
   • Patients in whom the attending clinician considers that active bleeding or on-going haemolysis contribute significantly to the cause of anaemia
   • Patients presenting with splenomegaly >5cm below the costal margin
7. Trial sites/locations and name of physician in charge of trial: Royal Bournemouth Hospital; Aberdeen Royal Infirmary; Great Western Hospital; Nottingham University Hospitals NHS Trust; St James Hospital, Leeds; Churchill Hospital, Oxford; Birmingham Heartlands Hospital; Freeman Hospital, Newcastle; Salisbury Hospital
8. More information:

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