Inclusion Criteria:

1. Diagnosis of MDS according to the WHO classification, but also including RAEB in
transformation as defined by the FAB classification (that is patients with up to 30%
of blasts in the bone marrow), with the exception of patients with preceding
myeloproliferative syndrome or LMMC;

2. Higher-risk MDS as defined by a IPSS score >1 (IPSS: Int-2 or High);

3. Life expectancy > 3 months;

4. Percentage of bone marrow blasts >10 and below 30%;

5. Ineligible for or having failed intensive chemotherapy and ineligible for or having
failed previous therapy with a hypomethylating agent;

6. Age ≥ 18 years;

7. Written informed consent;

8. Patient must understand and voluntarily sign consent form;

9. Patient must be able to adhere to the visit schedule as outlined in the study and
follow protocol requirements;

10. ECOG performance status between 0-2 at the time of screening;

11. Females of childbearing potential (defined as a sexually mature woman who has not
undergone a hysterectomy or who is not naturally postmenopausal for at least 24
consecutive months, that is who has had menses at any time during the preceding 24
consecutive months) have to have a negative pregnancy test;

12. Adequate contraceptive methods should be carried out by all patients during therapy
and for at least 2 weeks after completing therapy.

13. No existing contra-indication to treatment with erlotinib.

14. Health insurance.

Exclusion Criteria:

1. Serum creatinine ≥ 1.5 x the upper limit of normal, or creatinine clearance ≤60
mL/min.

2. Concomitant treatment with NSAIDS, warfarin, omeprazole, ranitidine or inducers (i.e.
rifampicin, phenytoin; carbamazepin) or inhibitors (i.e. ketoconazole, ciprofloxacin,
clarithromycin, voriconazole) of CYP3A4;

3. Inadequate liver function as defined by a serum bilirubin ≥ 1.5 x the upper limit of
normal (except in the case of confirmed moderate unconjugated hyperbilirubinemia due
to intramedullary hemolysis, as observed frequently in MDS), and/or ASAT/ALAT/GGT
levels ≥2 x the upper limit of normal;

4. Known HIV-positivity;

5. Any serious medical condition or psychiatric illness that will prevent the subject
from signing the informed consent form or will place the subject at unacceptable risk
if he or she participates in the study;

6. Vitamine B12 or folate deficiency;

7. Pregnant or lactating females;

8. Use of cytotoxic chemotherapeutic agents or experimental agents (agents that are not
commercially available) for the treatment of MDS within the 28 days preceding study
entry;

9. Prior history of malignancy other than MDS (except basal cell or squamous cell
carcinoma or carcinoma in situ of the cervix or breast), unless the subject has been
disease-free for ≥3 years;

10. Patients with a history of corneal disorders or another active ophthalmic disorder,
active infections or other concomitant serious and uncontrolled medical conditions.

11. History of interstitial lung disease or any active pulmonary disease.

12. Patients with a history of myeloproliferative syndrome or LMMC