Sekeres Assesses Imetelstat in Lower-Risk 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 the primary differences between imetelstat (Rytelo) and other treatments available for patients with low- to intermediate-1 risk myelodysplastic syndromes (MDS) with transfusion-dependent anemia who require at least 4 red blood cell units over 8 weeks and have not responded to or have lost response to or are ineligible for erythropoiesis-stimulating agents (ESAs).

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0:09 | When we have somebody who has lower-risk MDS with anemia, we start with drugs that have fewer [adverse events (AEs)] and have decent efficacy. Then we march along to where that efficacy and safety balance starts to shift. With ESAs, we have a lot of experience with them; they are not chemotherapy, they are hormonal therapy, and as I mentioned, they work and about 20% to 40% of people, but low-risk, moderate benefit.

0:48 | When we get to imetelstat, we have a pretty decent benefit. It works for 40% of people, so 40% of people treated with imetelstat went at least an 8-week period without needing a blood transfusion whereas when they started the study, they needed at least 4 bags of blood transfused over an 8-week period. So [it was] a pretty dramatic decrease in their blood transfusion needs, 40% of people. On average, it lasted for about a year. That's all the good stuff about imetelstat. Some of the AEs are that it can cause low blood counts. The neutrophils, the white blood cells, can go down substantially, and people ask, can the platelets? Again, we think moderate benefit, but slightly higher risk than where we started with ESAs.

1:46 | Some patients do not have those AEs. Some patients get a free ride. It is my favorite part of my day when the patient benefits from a drug and they do not have those sorts of AEs. For those who do, we have a couple of options. We can hold the drug and see if the AEs resolve and then restart it. We can also dose reduce and see if patients still get the benefit of being treated with imetelstat but without the cytopenias.