Approach to 1L Therapy Selection in Lower-Risk MDS

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Solly Chedid, MD, presents a patient case and provides clinical insights on approaching first-line therapy selection in patients with LR-MDS and moderate to severe anemia.

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    Case: Frontline Use of Erythroid Maturating Agent (EMA): Luspatercept

    Clinical Presentation:

    70-year-old man diagnosed 6 months ago with LR-MDS with multilineage dysplasia - moderate anemia (Hb 11.2) and thrombocytosis (PLT 500,000 μl)

    • SF3B1 mutation positive
    • Non-del(5q)
    • No family history of cancer or significant genotoxic agent exposure
    • IPSS-R: Low

    Current Visit Clinical Workup and Diagnosis:

    • Serum EPO - 250m U/L, Ring sideroblast (RS) negative
    • Hgb: 9.2 g/dL.
    • WBC and ANC: WNL
    • PLT: 450,000 μl

    He complains of increasing fatigue over the past 1-2 months. He normally plays 2-3 rounds of golf a week. Lately he has only been playing a full round once a week and maybe 9 holes on another day.

    Initial Treatment(s):

    • The patient was started on luspatercept at the starting dose [1.0 mg/kg] as 1L therapy.
    • After 24 weeks, the patient has not received any transfusion and his Hgb is now 10.7 g/dL.

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