Choosing Treatment for Lower-Risk MDS

EP: 1.Diagnosing Lower-Risk MDS

EP: 2.Classifying MDS: Updated WHO and ICC Guidelines

EP: 3.Risk Stratification Tools for MDS: IPSS, IPSS-R, IPSS-M

EP: 4.Importance of Early Detection and Unmet Needs in MDS

EP: 5.Lower-Risk MDS: Treatment Goals and Options

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EP: 6.Choosing Treatment for Lower-Risk MDS

EP: 7.Role of Stem Cell Transplant in MDS

EP: 8.MEDALIST: Clinical Implications in Lower-Risk MDS

EP: 9.Imetelstat and Canakinumab in Lower-Risk MDS

This is a video synopsis/summary of a Precision Medicine series featuring Hana Safah, MD, and Jamie Koprivnikar, MD.

Drs Safah and Koprivnikar discuss treatment selection considerations for lower-risk myelodysplastic syndrome (MDS) patients with anemia. For erythropoietin (EPO) levels above 500 mIU/mL, immunosuppression with antithymocyte globulin (ATG) is an option, while hypomethylating agents can be utilized if a patient’s disease is unfit for ATG. However, optimal management remains unclear in this subgroup.

For EPO under 500 mIU/mL, luspatercept is favored regardless of ring sideroblast status or other factors based on response durability and dosing convenience compared with erythropoiesis-stimulating agents. The exception is enrollment on clinical trials when available.

Despite equivalent responses to luspatercept vs epoetin alfa in ring sideroblast–negative patients, longer numerical duration of response and less frequent dosing support its use. Further research should uncover mechanisms and treatments providing additional benefit in this population.

Some lower-risk MDS patients with substantial transfusion needs and adverse molecular features may still warrant transplant referral if fit enough, which must be considered. Appropriate patient selection is integral to optimize outcomes.

Video synopsis is AI-generated and reviewed by Targeted Oncology® editorial staff.