COMMANDS Trial: Luspatercept Achieves Hematologic Improvement in Patients with MDS

A higher number of patients receiving luspatercept for low-risk myelodysplastic syndromes (MDS) achieved hematologic improvement (HI) erythroid (HI-E), neutrophil (HI-N), and platelet (HI-P) responses in the first 24 weeks versus those receiving epoetin alfa, according to updated data from the COMMANDS trial presented at the European Hematology Association 2024 Hybrid Congress.

The study, led by Guillermo Garcia-Manero, MD, of the University of Texas MD Anderson Cancer Center, evaluated the impact of luspatercept on safety and erythroid, neutrophil, and platelet lineages in erythropoiesis-stimulating agent (ESA)-naïve patients with low-risk MDS with or without ring sideroblasts.

A total of 182 patients were randomized 1:1 to receive either subcutaneous luspatercept 1.0-1.7 mg/kg once every three weeks or subcutaneous epoetin alfa 450-1050 IU/kg once weekly for at least 24 weeks.

Overall, 135 (74.2%) patients treated with luspatercept achieved HI-E, compared with 96 (53.0%) of those treated with epoetin alfa (P<.0001). The average time to HI-E was 15.5 days for patients receiving luspatercept and 25.1 days for those receiving epoetin alfa.

Fifteen (8.2%) patients treated with luspatercept and 16 (8.8%) of those treated with epoetin alfa had neutropenia at baseline. Of those, five (33.3%) patients receiving luspatercept and four (25.0%) receiving epoetin alfa achieved HI-N.

Twenty-six (14.3%) patients treated with luspatercept and 20 (11.0%) of those treated with epoetin alfa had thrombocytopenia at baseline. Of those, 11 (42.3%) patients receiving luspatercept and six (30.0%) receiving epoetin alfa achieved HI-P.

All grades treatment-emergent neutropenia occurred in seven (3.8%) patients treated with luspatercept and seven (3.9%) of those treated with epoetin alfa. All grades thrombocytopenia occurred in nine (4.9%) patients treated with luspatercept and one (0.6%) treated with epoetin alfa.

“Although only a minority of patients were evaluable for HI-P and HI-N assessments per the study entry criteria, more patients receiving luspatercept than epoetin alfa achieved HI-P and HI-N responses,” Dr. Garcia-Manero and colleagues concluded. “Luspatercept led to demonstrable improvements in erythroid, neutrophil, and platelet lineages, supporting its use in patients with ESA-naïve, [transfusion-dependent, lower-risk] MDS.”

Reference

Garcia-Manero G, Della Porta MG, Santini V, et al. Multilineage and safety results from the COMMANDS trial in transfusion-dependent, erythropoiesis-stimulating agent-naïve patients with very low-, low-, or intermediate-risk myelodysplastic syndromes. Abstract P780. Presented at the European Hematology Association 2024 Hybrid Congress; June 13-16, 2024; Madrid, Spain.