Quality of Life-Guided Transfusion in Refractory MDS or AML

Inclusion Criteria: * Adults aged 18 years and older. * Diagnosis of refractory MDS or AML, receiving palliative care only. * Anaemia with haemoglobin ≤ 8 g/dl at inclusion (or ≤ 9 g/dl if associated with cardiovascular disease). * Transfusion dependency, defined as requiring more than 2 GR transfusions every 8 weeks. * No vitamin B9, vitamin B12 or iron deficiency. * Ability to understand and sign the informed consent form. * Ability to comply with the schedule of visits and other protocol requirements. Non inclusion Criteria: * Previous malignant disease other than MDS or AML (except basal cell or squamous cell carcinoma or carcinoma in situ of the cervix or breast). * Active uncontrolled infection (hepatitis B or C, HIV). * Use of G-CSF. * Confirmed neurocognitive disorders (based on prior diagnosis or clinical assessment by the investigator) impairing comprehension, consent or the ability to reliably complete the EQ-5D-5L questionnaire. * Active uncontrolled heart disease. * Active haemolytic anaemia. * Recent major surgery. * Life-threatening complications of MDS/AML. * Presence of another serious or unstable disease which, in the investigators' opinion, would make participation in the study inappropriate or risky for the patient's safety. * Vulnerable individuals. Exclusion Criteria: * Immediate severe complications related to MDS/AML, such as uncontrolled bleeding, pneumonia with hypoxia or shock, or severe disseminated intravascular coagulopathy. * Withdrawal of the patient's voluntary informed consent.