“How I treat” a patient with lower-risk MDS showing signs of ESA failure

During the MDS Hub Steering Committee meeting, held on October 26, 2023, Theo de Witte chaired a discussion on “How I treat” a patient with lower-risk myelodysplastic syndromes (MDS) showing signs of ESA failure, with contributions from Pierre Fenaux and Rafael Bejar.

Theo de Witte discusses the optimal timing of erythropoiesis-stimulating agent (ESA) treatment in patients with lower-risk MDS and how to optimize treatment following ESA-treatment failure, including the use of luspatercept; he highlights results from the phase III MEDALIST (NCT02631070) and COMMANDS (NCT03682536) trials. The committee also discusses the assessment of quality of life in placebo-controlled studies and the use of luspatercept as a first-line therapy over ESAs, specifically in patients with MDS and SF3B1 mutations. They also raise the need to consider the side effects of luspatercept and the cost of treatment.