Discussing the Impact of Luspatercept on Cell Lineages in MDS

In a series of roundtable discussions, an expert panel moderated by Jamile Shammo, MD, of Northwestern University, explored current issues in myelodysplastic syndrome (MDS) care. The panel included David Swoboda, MD, of the Tampa General Hospital; Saeed Sadeghi, MD, of the David Geffen School of Medicine at UCLA; and Christopher Benton, MD, of the Rocky Mountain Cancer Centers.

In this segment, the roundtable discusses the abstract, “Multilineage and Safety Results From the COMMANDS Trial in Transfusion-Dependent (TD), Erythropoiesis-Stimulating Agent (ESA)-Naïve Patients With Very Low-, Low-, or Intermediate-Risk Myelodysplastic Syndromes (MDS),” presented by Guillermo Garcia-Manero, MD, at the Twelfth Annual Meeting of the Society of Hematologic Oncology.

“Essentially, the results suggest that luspatercept led to demonstrable improvement in erythroid, neutrophil, and platelet lineages, which supports its use in patients with ESA-naïve, transfusion-dependent, low-risk MDS,” Dr. Shammo said.

Commenting on the findings, Dr. Benton noted that while SF3B1-mutated patients typically only have depressed red blood cell and hemoglobin levels, different mutational profiles can have other cell lines suppressed.

“This is something that we’ve seen in clinical practice when we give luspatercept, we actually see some improvements in the [absolute neutrophil count] and the platelet count as well,” Dr. Benton said. “So you have to think that luspatercept could, in individual patients, achieve some additional benefit.

Dr. Benton added that the data suggest that transforming growth factor beta inhibition may be relevant in other cell line populations, “either in maturation or maybe even in the stem cell population and not just the erythroid lineage.”

Dr. Swoboda and Dr. Sadeghi pointed out that the findings are limited by the small sample size of the analysis and need further investigation, though Dr. Shammo added she was happy that the data at least suggest a positive trend with luspatercept as opposed to a negative trend.