SF3B1+ MDS-RS: IPSS-M-Guided 1L Luspatercept : Episode 4
COMMANDS Trial: Efficacy and Safety Findings
Jamie Koprivnikar, MD, discusses how findings from the COMMANDS trial can be used to inform treatment decisions for patients based on serum EPO levels and the presence or absence of ring sideroblasts.
Case: SF3B1+ MDS-RS: IPSS-M-Guided 1L 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
- IPSS-M: SF3B1α mutation [SF3B1, ASXL1 and TET2 mutations]
Current Visit Clinical Workup and Diagnosis:
- Serum EPO - 250m U/L, Ring sideroblast (RS) agnostic (either positive or negative)
- Hgb: 8.2 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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