Utilizing ESA’s in Clinical Practice

Erythropoiesis-stimulating agents (ESAs) remain a first-line treatment for anemia in patients with low-risk MDS, especially those with lower endogenous erythropoietin levels and modest transfusion requirements. In practice, a meaningful proportion of patients ultimately prove unresponsive or lose response over time. Clinically, lack of response is assessed through persistent anemia, continued transfusion needs, and limited improvement in hemoglobin levels despite adequate dosing. While some clinicians may trial a different ESA formulation, switching rarely produces substantial benefit once primary resistance is evident. Identifying non-responders early allows for timely transition to alternative therapies and more personalized anemia management strategies.