Case: A 70-Year-Old Man With Anemia in ESA-Naive Lower-Risk 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.
This case highlights a typical patient with lower-risk myelodysplastic syndrome (MDS) presenting with anemia and mild fatigue. The patient, who remains active and lives a moderate distance from his treatment center, was initially diagnosed with multilineage dysplasia and elevated platelet counts. His lab work showed a hemoglobin level of 8.3 g/dL and an erythropoietin level of 200 mU/mL, without deletion 5q or SF3B1 mutation. He had received occasional red blood cell transfusions but had not been treated with erythropoiesis-stimulating agents (ESAs) prior to evaluation. Given the symptomatic anemia and transfusion history, the therapeutic focus was on improving hemoglobin levels while minimizing treatment burden.
Among the treatment options discussed were weekly subcutaneous ESAs versus luspatercept every 3 weeks. Luspatercept was chosen, given its convenience and alignment with the patient’s lifestyle and logistical needs. The clinical rationale is supported by findings from recent trials showing that, in ESA-naive patients with low-risk MDS, luspatercept can provide superior rates of transfusion independence and hemoglobin improvement. The every-3-week dosing schedule also allows for less frequent clinic visits, an important consideration for patients balancing daily responsibilities and transportation challenges. Following initiation, the patient achieved a hemoglobin rise to 9.2 g/dL and remained transfusion independent, suggesting a favorable early response.
Setting patients up for success with MDS therapy involves clear communication about treatment expectations, potential adverse effects, and the timeframe for clinical benefit. In cases of mild to moderate anemia where symptoms are present but not critical, starting with luspatercept is a reasonable strategy. Adjusting the dose over time can further enhance outcomes. The ultimate goals are to alleviate symptoms, reduce transfusion dependence, and improve quality of life—objectives well aligned with luspatercept’s demonstrated efficacy and manageable administration schedule.
