Over eight years of transfusion independence with continuous erythropoietin receptor activator and Roxadustat in transfusion-dependent low-risk myelodysplastic syndrome

We report a case of a 65-year-old Japanese woman with low-risk myelodysplastic syndrome (MDS) on hemodialysis who achieved transfusion independence for over eight years with combined epoetin beta pegol (continuous erythropoietin receptor activator, CERA) and roxadustat. Transfusion-dependent since 2008, she showed a temporary response to darbepoetin and CERA, initiated in August 2016. Roxadustat was added in January 2020, leading to sustained transfusion independence. No serious adverse events, such as progression to acute leukemia or clinically significant thyroid dysfunction, were observed during this period.