Case: A 67-Year-Old Woman With Anemia in ESA-Naive Lower-Risk MDS

Video content above is prompted by the following:

This segment presents a detailed case study of a 67-year-old postmenopausal woman diagnosed with lower-risk myelodysplastic syndrome (MDS) who presented with symptomatic anemia. The patient experienced progressive fatigue and dyspnea on exertion over 6 months, with hemoglobin levels declining from 9.1 g/dL to 8.8 g/dL. Notably, she had no family history of cancer and no chemical or radiation exposure, and was current with age-appropriate cancer surveillance including colonoscopy.

The diagnostic workup revealed significant dysplasia in bone marrow biopsy with ring sideroblast negative status, 4% blasts, normal cytogenetics without deletion 5q, and negative next-generation sequencing including SF3B1 mutation. Her Revised International Prognostic Scoring System score classified her as lower-risk MDS, with a baseline erythropoietin level of 87. The comprehensive evaluation ruled out alternative causes of anemia, establishing a definitive diagnosis of lower-risk MDS requiring treatment intervention.

After thorough discussion of treatment options including active surveillance with as-needed transfusions, weekly erythropoiesis-stimulating agents (ESAs), or subcutaneous luspatercept every 3 weeks, the patient elected to proceed with luspatercept at the standard starting dose of 1 mg/kg. This case exemplifies the typical presentation and diagnostic approach for patients with ESA-naive lower-risk MDS, highlighting the importance of comprehensive evaluation and patient-centered treatment selection in managing this hematologic malignancy.