A 70-Year-Old Man with Anemia in ESA Naive Lower-Risk Myelodysplastic Syndrome (LR-MDS)

A panelist discusses a typical lower-risk myelodysplastic syndrome case managed with luspatercept over erythropoiesis-stimulating agents due to its convenient every-3-week dosing and favorable early response, emphasizing how treatment decisions should align with patient lifestyle, anemia severity, and goals of improving hemoglobin levels, minimizing transfusions, and enhancing quality of life.

A panelist discusses the evolving role of luspatercept in low-risk myelodysplastic syndrome, highlighting its broad efficacy beyond SF3B1 mutations, its advantage in reducing transfusions and improving quality of life, and the shift toward treatment decisions based on clinical presentation and lifestyle factors rather than genetic profiles alone.

A panelist explains how the distinct mechanisms of erythropoiesis-stimulating agents (ESAs), luspatercept, and imetelstat offer tailored treatment options for anemia in lower-risk ESAs, enabling clinicians to address different stages of erythropoiesis and disease biology to optimize patient outcomes.

A panelist emphasizes that treatment decisions for anemia in low-risk myelodysplastic syndrome should be guided by symptoms and functional status rather than strict hemoglobin thresholds, with erythropoiesis-stimulating agents or luspatercept often initiated before transfusion dependence to improve quality of life and potentially delay disease progression.

A panelist highlights that updated COMMANDS trial data demonstrate luspatercept’s robust efficacy in erythropoiesis-stimulating agent–naive patients with low-risk myelodysplastic syndrome—achieving high rates of durable transfusion independence and hemoglobin improvement across subgroups—with emerging evidence suggesting potential long-term survival benefits and a favorable safety profile.

A panelist emphasizes that recent real-world retrospective data from 103 first-line luspatercept-treated patients closely align with, and even slightly exceed, COMMANDS trial results—demonstrating significant hemoglobin improvements and transfusion independence—thereby reinforcing luspatercept’s effectiveness and practical value in routine clinical care for erythropoiesis-stimulating agent–naïve, low-risk patients with myelodysplastic syndrome.

A panelist highlights that after initial hemoglobin decline despite dose escalation, further increasing luspatercept dosing led to transfusion independence and hemoglobin improvement, underscoring the critical role of regular monitoring and timely dose adjustments to optimize anemia management in low-risk myelodysplastic syndrome.

A panelist notes that while new treatments like luspatercept and imetelstat offer hope beyond traditional erythropoiesis-stimulating agents—which fail in many patients and provide limited response duration—variability in patient response, influenced by factors such as mutation burden, underscores the need for personalized therapies and continued development of agents that can modify disease progression and improve survival in low-risk myelodysplastic syndrome.