Durable Transfusion Independence in Lower-Risk MDS
Gary J. Schiller, MD, reviews recent data on durable transfusion independence for patients with lower-risk MDS in the IMerge phase 3 study and discusses how transfusion frequency affects patient outcomes.
This is a video synopsis of a discussion featuring Gary J. Schiller, MD, chief of the Hematological Malignancy/Stem Cell Transplantation program at the David Geffen School of Medicine at UCLA Health Jonsson Comprehensive Cancer Center.
In an abstract presented by Komrokji et al. from 4 US centers and 1 center in India, the impact of transfusion dependence on survival in lower risk MDS was analyzed.
The endpoint of transfusion independence is used in many MDS trials but can be problematic. Definitions may vary across sites and over time based on dynamic transfusion thresholds. Also, transfusion independence was not tied to a significant objective hemoglobin increase in these trials.
Nevertheless, the authors used a large US payer-based database of commercial and Medicare Advantage health claims to identify over 5600 patients with lower-risk MDS (median age 79 years) who received ≥1 lines of therapy.
As expected, red blood cell transfusion dependent patients had poorer survival compared to transfusion independent patients in first- and second-line treatment. The authors conclude transfusion dependence may be a modifiable risk factor to improve outcomes.
However, as Dr Santini showed, transfusion dependence reflects underlying higher risk molecular biology. It likely identifies patients with poorer prognosis rather than being directly modifiable to improve survival. Distinguishing between MDS disease characteristics versus the effects of transfusion dependence on outcomes requires prospective trials.
Retrospectively, impressive Kaplan-Meier curves clearly show transfusion dependent lower risk MDS patients have significantly shorter survival compared to transfusion independent patients.
*Video synopsis is AI-generated and reviewed by Targeted Oncology editorial staff.
