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Transfusion Independence Serves as Key End Point for LR-MDS Trials

Saeed Sadeghi, MD, clinical professor of medicine at the David Geffen School of Medicine at UCLA in Los Angeles, California, discusses the findings on transfusion independence achieved with treatment for patients with low-risk myelodysplastic syndrome (LR-MDS).

A key takeaway that Sadeghi from Case-Based Roundtable event was the superiority shown the phase 3 COMMANDS trial (NCT03682536) with luspatercept-aamt (Reblozyl) in terms of red blood cell transfusion independence and an increase in hemoglobin level compared with epoetin alfa in patients who had not received prior erythropoietin-stimulating agent (ESA). Luspatercept was also showed to be effective in the MEDALIST trial (NCT02631070) in patients who had been previously treated with ESA and were refractory to it or had a serum epoetin level of 200 U/L or higher.

He notes that in an ESA-refractory or relapsed patient population, imetelstat (Rytelo) was investigated in the IMerge trial (NCT02598661) in comparison with placebo and met its primary end point of 8-week transfusion independence. With the data supporting these newer agents, patients with LR-MDS have access to treatment options as an alternative to ESAs to improve anemia and avoid the need for frequent transfusions.

TRANSCRIPTION:

0:10 | Some important key takeaways are that in terms of luspatercept, luspatercept definitely has superiority. There are high response rates in terms of transfusion independence for 12 weeks, as well as improvement of the hemoglobin level of 1.5 g/dL in patients that this was statistically significant, and this was shown in a patient population that had not been exposed to ESAs.

0:37 | Alternatively, in a patient population that had previously been treated with ESAs and were either refractory or they had a high serum epoetin level of greater than 200, luspatercept was also shown to be beneficial in this patient population compared [with] placebo in the MEDALIST trial and also improved the transfusion-free interval in patients that is statistically significant. Finally, in more refractory patient population, patients who had failed ESAs, imetelstat given every 4 weeks has [been] demonstrated to improve transfusion independence for patients as well.