Dapagliflozin for Anemia in Lower-Risk Myelodysplastic Syndromes

Inclusion Criteria: * Adults aged ≥18 years * Diagnosis of myelodysplastic syndromes (MDS) according to WHO or ICC criteria * Revised International Prognostic Scoring System (IPSS-R) very low, low, or intermediate risk * Hemoglobin ≤10 g/dL at screening * Transfusion independent or low transfusion burden (Defined as ≤2 units of red blood cell transfusion within 8 weeks prior to enrollment) * If receiving erythropoiesis-stimulating agents (ESA) or other anemia-directed therapy, on a stable dose for at least 8 weeks prior to enrollment * Eastern Cooperative Oncology Group (ECOG) performance status 0-2 * Absolute neutrophil count (ANC) ≥0.75 ×10⁹/L * Platelet count ≥50 ×10⁹/L * Adequate organ function: Creatinine clearance ≥30 mL/min AST or ALT ≤3 × upper limit of normal Exclusion Criteria: * IPSS-R intermediate-high or high-risk MDS * Transformation to acute myeloid leukemia or ≥20% blasts * Initiation or dose change of MDS- or anemia-directed therapy (e.g., ESA, luspatercept, hypomethylating agents) within 8 weeks prior to screening * Red blood cell transfusion \>2 units within 8 weeks prior to enrollment * Current use of SGLT2 inhibitors or history of serious adverse reaction to SGLT2 inhibitors * Uncontrolled diabetes mellitus (e.g., HbA1c \>10%) or history of diabetic ketoacidosis * Estimated glomerular filtration rate (eGFR) \<30 mL/min/1.73 m² * Active or uncontrolled infection * Absolute neutrophil count (ANC) \<0.75 ×10⁹/L or platelet count \<50 ×10⁹/L * Pregnant or…