Dr. Raddi on Predictors of Response to ESA in MDS

Blood Cancers Today spoke with Marco Gabriele Raddi, MD, of Careggi University Hospital, to discuss his study that conducted flow cytometric analyses of patients with lower-risk myelodysplastic syndromes (MDS) to identify predictors of response to erythroid-stimulating agents (ESAs). The findings were published in Blood Cancer Journal.

“This study was born with the idea of trying to identify more specific predictors of response to the standard treatment, which is ESAs,” Dr. Raddi said. “But right now, the current landscape of the treatment of anemia in low-risk MDS is changing given the approval of luspatercept in the first line.”

Dr. Raddi and colleagues retrospectively analyzed patients with lower-risk MDS who received ESA treatment. They reviewed molecular and erythrite population factors that were associated with long response—defined as longer than 24 months.

“The main finding of our study was that [patients who had a long response] had significant increase in the expansion of immature erythroid precursors in the bone marrow at baseline, so before receiving treatment,” Dr. Raddi said. “These precursors can be easily recognized with flow cytometry given the expression of CD71, which is a threat marker, along with 117 positivity, which defines early-stage erythropoiesis.”

Dr. Raddi added that 170-positive erythroid precursors were significantly increased in patients with a sustained response compared with nonresponders and also a group of control patients.

When considering whether the data could inform treatment choice between ESAs and luspatercept, Dr. Raddi noted the results do need to be validated in larger cohorts, and additional biomarkers are needed.

“From my perspective, in future, molecular information will be very helpful in discriminating ESA responders from nonresponders,” Dr. Raddi suggested.