The Impact of Luspatercept Versus ESAs on Cytopenias in Lower-Risk MDS

By Patrick Daly - Last Updated: September 26, 2024

Compared with epoetin alfa, treatment with luspatercept yielded greater rates of improvement in cytopenias for erythropoietin-stimulating agent (ESA)-naïve patients with transfusion-dependent, lower-risk myelodysplastic syndromes (MDS), according to an analysis of the COMMANDS trial.

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The data were presented by Guillermo Garcia-Manero, MD, of The University of Texas MD Anderson Cancer Center, at the Society of Hematologic Oncology 2024 Annual Meeting in Houston, Texas.

COMMANDS enrolled patients aged 18 years and older with lower-risk MDS with or without ring sideroblasts who had under 5% bone marrow blasts, under 500 U/L endogenous serum erythropoietin, and transfusion dependency (2-6 units/8 weeks for ≥8 weeks prior to randomization).

By the March 2023 data cutoff, 135 of 182 (74.2%) patients treated with luspatercept achieved erythroid hematologic improvement compared with 96 of 181 (53.0%) patients treated with epoetin alfa (P<.0001). The mean time to erythroid improvement was 15.5±27.5 days with luspatercept versus 25.1±32.7 days with epoetin alfa.

Fifteen of 182 (8.2%) patients in the luspatercept group and 16 of 181 (8.8%) patients in the epoetin alfa groups had neutropenia at baseline. Of these, five (33.3%) in the luspatercept group and four (25.0%) in the epoetin alfa groups achieved neutrophil improvement.

Twenty-six of 182 (14.3%) luspatercept patients and 20 of 181 (11.0%) epoetin alfa patients had thrombocytopenia at baseline. Of these, 11 (42.3%) in the luspatercept group and six (30.0%) in the epoetin alfa group achieved platelet improvement.

Over 24 or more weeks of treatment, 116 of 182 (63.7%) and 138 of 181 (76.2%) patients in the luspatercept and epoetin alfa groups, respectively, received red blood cell transfusions. Six patients in each group received platelet transfusions.

Between weeks one and 24, seven (3.8%) patients treated with luspatercept and seven (3.9%) treated with epoetin alfa experienced treatment-emergent neutropenia of any grade. Additionally, nine (4.9%) luspatercept recipients and one (0.6%) epoetin alfa recipient experienced thrombocytopenia of any grade.

“Luspatercept versus epoetin alfa led to demonstrable improvements in erythroid, neutrophil, and platelet lineages, supporting its use in patients with ESA-naïve, transfusion-dependent lower-risk MDS,” Dr. Garcia-Manero and colleagues concluded.

Reference

Garcia-Manero G, Della Porta MG, Santini V, et al. 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). Abstract #MDS-167. Presented at the Society of Hematologic Oncology 2024 Annual Meeting; September 4-7, 2024; Houston, Texas.

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