Katja Sockel, MD, on New Advances, Continuing Issues in Lower-Risk MDS

Katja Sockel, MD, of University Hospital Carl Gustav Carus Dresden in Germany, spoke with Blood Cancers Today at the European Hematology Association (EHA) 2024 Hybrid Congress in Madrid, Spain. She described the latest developments in the management of lower-risk myelodysplastic syndromes (MDS).

According to Dr. Sockel, this clinical field saw major advances in the last year, “especially the extended approval of luspatercept for virtually all transfusion-dependent low-risk MDS patients.” Also welcome was the US Food and Drug Administration’s recent approval of imetelstat for “high transfusion burn” patients, and Dr. Sockel noted European clinicians’ hope for approval by the European Medicines Agency.

She mentioned other drugs similar to luspatercept are currently being investigated for use in this setting, as well as agents with differing mechanisms, such as activin receptor ligand traps and anti-inflammatory drugs.

However, Dr. Sockel feels there are certain unresolved issues in lower-risk MDS management. One is how patient selection affects the development of new treatments and how to improve such selection. As an example, she highlighted that inflammatory changes play a key role in MDS pathogenesis, and “including this so-called ‘immunome,’ or immunological, data might improve our patient selection.”

A shortcoming in current therapies Dr. Sockel pointed out is that most drugs are only approved for transfusion-dependent patients, and “if you have a symptomatic anemia but are not transfusion dependent, you can only get erythropoietin in an ‘approved’ manner.” However, she looks forward to new data that address this.

In Dr. Sockel’s view, there is also a need to reconsider what the goal of treatment is in this setting. “In the moment, our goal is to improve the symptoms and reduce transfusion requirements, but I think we should focus more on disease modification to avoid disease progression or, at least, prolonged disease progression,” she said.

She mentioned that clinicians are now exploring new directions in lower-risk MDS management, such as possibly using combination therapies or intervening earlier at pre-MDS stages.

Dr. Sockel feels the data on lower-risk MDS being presented at EHA 2024 are exciting, and said, “I think the future looks bright for our patients.”