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Myelodysplastic syndromes (MDS) are clonal stem cell disord ers that primarily affect older persons and are associated with peripheral blood cytopenias, increased risk of conversion to acute myeloid leukemia and shortened survival. Treatment strategies in MDS are guided by patient risk categories, with higher -riskpatients receiving more aggressive interventions. Patients with lower -risk MDS receive less aggressive therapies or supportive care/red blood cell transfusion. Transfusion -dependent patients with lower risk MDS are likely to develop iron overload because o f their longer predicted survival and, hence, greater transfusion burden. Transfusion requirement and elevated serum ferritin further complicate the treatment landscape because they have dose -dependent effects on overall and leukemia -free survival, with in creasing serum ferritin levels associated with increased risk of death. Lower iron burden could provide a survival benefit, and an association with improved survival has been shown in retrospective studies. However, lack of random assignment to treatment i

Iron Overload, Chelation Therapy and Survival in Lower-Risk Myelodysplastic Syndromes: State of the Evidence