Objective To investigate the overall and subgroup efficacy， subgroup differences， predictors of efficacy and safety of roxadustat in the treatment of refractory non-severe aplastic anemia （NSAA） and low-risk myelodysplastic syndromes （LR-MDS）. Methods Patients with refractory NSAA and LR-MDS who were admitted to the Department of Hematology， Peking Union Medical College Hospital from August 2020 to December 2022 were enrolled. All patients received first-line standard treatment， including recombinant human erythropoietin （rhEPO） for at least 3 months before roxadustat treatment. All patients received roxadustat 2.5 mg/kg every other day for at least 3 months， and were followed up for at least 8 months. The clinical characteristics of patients， roxadustat efficacy， predictors of efficacy， adverse effects，relapse and disease clonal evolution were analyzed. Results A total of 40 patients including 24 refractory NSAA and 16 LR-MDS were included. median age was 56 （18 ~ 81） years and 40% were males. 65% of the patients were transfusion dependent. Median follow-up was 21 （9 ~ 34） months. 22.5%， 25.0%， 47.5% ， 55.0%， 57.5%， 60.0% and 50.0% of the patients achieved haematological improvement-erythroid （HI-E） at months 1， 2， 3， 4， 5， 6， and end of the follow-up period， respectively， and no factors affecting HI-E were identified.The hemoglobin change from baseline was statistically different between the two groups at the end of the follow-up period. 50% of patients were relieved from transfusion dependence. Adverse reactions were reported in 22.5% of patients. 28.5% of patients relapsed after achieving HI-E， with a median time to relapse of 7（4 ~ 12） months. No clonal evolution was observed at the end of the follow-up period. Conclusions Our preliminary findings suggested that Roxadustat may be effective for patients with NSAA or LR-MDS refractory to conventional therapies and rhEPO， with mild adverse effects and low relapse rate.The degree of hemoglobin improvement may be better in the refractory NSAA patients.