The FDA has approved imetelstat for adults with low- to intermediate-1 risk myelodysplastic syndromes (MDS) and transfusion-dependent anemia requiring ≥4 red blood cell units over 8 weeks. It is indicated for patients unresponsive, resistant, or ineligible for erythropoiesis-stimulating agents (ESAs). Imetelstat, a telomerase inhibitor, addresses a critical unmet need in this patient population.