Benefits and Limitations of Long-term Red Blood Cell Transfusions in Patients with Low-risk MDS

Long-term red blood cell transfusions remain a foundational supportive therapy for patients with low-risk MDS, offering rapid symptom relief and improved energy levels. However, chronic transfusions come with significant limitations, including iron overload, increasing transfusion burden, and logistical challenges that can negatively impact quality of life. When aiming to reduce transfusion burden, luspatercept is often considered first-line in eligible patients because it can achieve durable hematologic improvement and delay the need for transfusions. Still, its use depends on patient characteristics, prior ESA exposure, and individual response profiles.