Ring Sideroblasts Status Affects Treatment Decisions for Frontline MDS

EP: 1.How the Frontline Indication for Luspatercept Impacts Anemia in MDS

EP: 2.Subgroup Analyses of COMMANDS Trial Favor Luspatercept in MDS

EP: 3.Luspatercept Shows Clinically Meaningful Improvement Over ESAs in MDS

EP: 4.Zeidan Reviews Past Treatment Options for Patient With Lower-Risk MDS

EP: 5.COMMANDS Trial Shows Positive Result in MDS Despite Pandemic

EP: 6.Luspatercept in MDS Promotes Transfusion Independence and Anemia Response

EP: 7.Genetics and Ring Sideroblasts Impact ESA-Refractory Anemia in MDS

EP: 8.COMMANDS Trial Demonstrates Benefit Across Mutations in RS-Positive LR-MDS

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EP: 9.Ring Sideroblasts Status Affects Treatment Decisions for Frontline MDS

EP: 10.Therapies With Different Mechanisms of Action Available for Low-Risk MDS

EP: 11.Dose Escalation of Luspatercept Is Underutilized in MDS

Amer Zeidan, MBBS, associate professor of internal medicine (Hematology), chief of hematologic malignancies and director of early therapeutics research for Hematology, and leader of the clinical research team for leukemias and myeloid malignancies at the Yale Cancer Center, discusses how ring sideroblasts status affects using luspatercept-amt (Reblozyl) in patients with myelodysplastic syndromes (MDS).

During a Case-Based Roundtable event, Zeidan talked with event participants about when to use luspatercept vs erythropoiesis-stimulating agents (ESAs) in patients with ring sideroblast–negative disease. When luspatercept was investigated in the COMMANDS trial (NCT03682536), most of the population were ring sideroblast positive. Zeidan said this limited the sample size of population without ring sideroblasts as well as the number of patients with transfusion independence.

According to Zeidan, transfusion burden, baseline erythropoietin (EPO) levels, and the presence of other mutations are crucial factors to consider when deciding on ESA use for patients without ring sideroblasts.

TRANSCRIPTION:

0:10 | There was a lot of discussion about the specific patient characteristics that would prompt someone to use luspatercept over ESA in patients who are ring sideroblast negative. This is the most challenging aspect of the COMMANDS trial, because the COMMANDS trial did enroll patients regardless of the ring sideroblast status, but most of the patients—more than two-thirds of the patient who entered the study—were ring sideroblast positive, which limited the number of ring sideroblast negative patients. Also the rate of transfusion independence was not as high among patients who are ring sideroblast negative compared [with] those who are ring sideroblast positive.

0:52 | I think I made the point that it's not only the presence of the ring sideroblasts but also we look at other factors, such as how heavy is the transfusion burden, what is the baseline EPO level, and [what is] the number of other mutations that are present in the patient? All of these factors kind of play in my mind, in terms of [whether] you start with luspatercept or ESA in a patient who does not have ring sideroblasts.