Early treatment initiation in lower-risk myelodysplastic syndromes produces an earlier and higher rate of transfusion independence

•How does active therapy (AT) timing impact transfusion dependence (TD) in MDS?•Early AT initiation was associated with more transfusion independence (TI).•Fewer early initiators used erythropoietin-stimulating agents before gaining RBC-TI.•RBC-TI was more frequent in patients who met minimum therapy exposure.•Higher rates of RBC-TI were associated with less time between TD and AT initiation.