Clinical Considerations for Erythrocyte-stimulating Agents and Luspatercept

When choosing between ESAs and luspatercept as first-line therapy in low-risk MDS, clinicians typically weigh disease biology, patient characteristics, and predictors of response. Additional factors—such as transfusion burden, comorbidities, and patient preferences—also shape the decision. While combination therapy is an emerging area of interest, current data remain limited, and the approach is not yet standard practice. Ongoing studies may clarify whether sequential or combined use can optimize durability of response and reduce transfusion dependence.