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Objective: This study aimed to evaluate the clinical efficacy of epoetin alfa and darbepoetin alfa in patients with myelodysplastic syndromes (MDS) in the real-life setting. Methodology: A total of 204 patients with low-risk or intermediate-1-risk MDS who received epoetin alfa or darbepoetin alfa were included. Hemoglobin levels and transfusion need were recorded before and during 12-month treatment. Results: Hemoglobinlevelsweresignificantlyhigherateachfollowupvisitwhencomparedtobaseline levelsinbothepoetinalfaanddarbepoetinalfagroups.Transfusionneedsignificantly decreasedfrombaselineateachstudyvisi intheepoetinalfagroupandonlyatthe12thmonth visitinthedarbepoetinalfagroup.Hemoglobin levels or transfusionneedwassimilarbetween treatmentgroups. Conclusion: This reallife retrospective study revealed similar efficacy of epoetin alfa and darbepoetin alfa among low risk or intermediate-1 risk MDS patients with no difference in treatment response between treatment groups, whereas a likelihood of earlier treatment response in the epoetin alfa group(figure 1).