Quality of Life Considered When Starting Treatment in MDS

EP: 1.A Deep Dive Into the FDA Approval of Imetelstat in Lower-Risk MDS

EP: 2.Transfusion Independence Sustained With Imetelstat in Low-Risk MDS

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EP: 3.Quality of Life Considered When Starting Treatment in MDS

EP: 4.Significance of New Therapeutic Options in MDS and Other Blood Cancers

EP: 5.Patient Selection for Imetelstat Benefits From Considering AEs

EP: 6.Dealing With Transfusion Dependence in Patients With MDS

Mikkael A. Sekeres MD, MS, professor of medicine and chief of the Division of Hematology, Leukemia Section at the University of Miami Health System, Sylvester Comprehensive Cancer Center, discusses when he decides to start therapy for anemia in patients with low-risk myelodysplastic syndromes (MDS).

If a patient is receiving at least red blood cell transfusion each month, Sekeres says that is when he will start them on treatment. Erythropoiesis-stimulating agents (ESAs) are the common option for patients who are transfusion dependent, but therapeutic choices will depend on the serum erythropoietin (EPO) level and level of red blood cell transfusion dependency.

According to Sekeres, patients with higher serum EPO level do not respond to ESAs as much as those with low serum EPO levels. Other options are available for these patients with high serum EPO levels, such as luspatercept-aamt (Reblozyl). If patients have already received or are ineligible for ESAs, imetelstat (Rytelo) is also an option.

Transcription:

0:10 | We usually start therapies in patients when they become dependent on red blood cell transfusions. Now, how do we define that? Sometimes we'll say that a patient requires about 2 bags of blood every 8 weeks, or 1 bag of blood every month. And I think once my patients start to require a transfusion of a bag of blood a month or more frequently, it really starts to impact their quality of life. So that's when I start to consider treatments for transfusion-dependent anemia in my lower-risk patients with MDS.

0:45 | Now, one of the first treatments we often turn to are ESAs. Why? Well, they're relatively easy. They have a recognizable [adverse event] profile, and they're not a form of chemotherapy. So patients who aren't yet dependent on red blood cell transfusions or highly dependent on red blood cell transfusions, and patients who have a lower serum EPO level—we typically define lower as less than 200 IU/L—are more likely to respond to ESAs like [epoetin] or darbepoetin. On the other hand, patients [who] will have a higher serum EPO level, let's say a serum EPO level greater than 500 IU/L, who are already requiring frequent red blood cell transfusions, are less likely to respond to ESAs. So we start with the basics, and we start with what's easy, ESAs.