Examining Patients with Low Erythropoietin Levels and Low-risk MDS

In managing patients with low-risk MDS and low endogenous erythropoietin (EPO) levels, the primary goal is to improve anemia and reduce transfusion dependence. Traditionally, erythropoiesis-stimulating agents (ESAs) are the first-line therapy, given their established efficacy in patients with low EPO and lower transfusion burdens. However, the COMMANDS trial subgroup data have reshaped clinical decision-making by demonstrating that luspatercept can achieve higher rates of transfusion independence and improved hemoglobin responses compared with ESAs in this population. These findings support earlier consideration of luspatercept, particularly for patients who are ESA-refractory or unlikely to respond.