What Are the Treatment Options for Patients with Low-Risk MDS?

A roundtable discussion, moderated by Guillermo Garcia-Manero, MD, Blood Cancers Today Associate Editor, of the University of Texas MD Anderson Cancer Center, focused on the latest data in the treatment of low-risk myelodysplastic syndromes. Dr. Garcia-Manero was joined by Jamie Koprivnikar, MD; George Yaghmour, MD; and Sangeetha Venugopal, MD.

In the first segment of the roundtable series, the panel discussed the current slate of treatment options for patients with low-risk myelodysplastic syndromes.

Watch the next segment in this series.

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Dr. Garcia-Manero: Sangeetha, tell us how we define lower risk myelodysplastic syndromes (MDS) and what options do we have right now in practice?

Dr. Venugopal: Lower-risk myelodysplastic syndromes, we broadly define as two categories: a del(5q), which is a lower-risk MDS, and we have an approved treatment option for that—lenalidomide. The other one is non-del(5q). Until now, we didn’t have any drug options that were specifically evaluated in myelodysplastic syndromes. Until now we have been only using recombinant erythropoietin and for transfusion-dependent anemia or symptomatic anemia.

Now the second option we had until recently was luspatercept, which was approved for second-line treatment in patients who have already been either resistant or refractory to recombinant erythropoietin. Now the most recent COMMANDS trial that evaluated luspatercept in the first-line setting in patients who are treatment naïve to recombinant erythropoietin.

Dr. Garcia-Manero: Anything to add, George or Jamie?

Dr. Yaghmour: I do agree. It’s fascinating where we are moving in the treatment of low-risk MDS, especially to cover the unmet needs, especially the anemia and transfusion independency and excited to see what’s going on this ASH [2023 Annual Meeting].

Dr. Garcia-Manero: Jamie, anything different that you do in your practice?

Dr. Koprivnikar: No, I think I have the same approach. Obviously seeing these patients doing a bone marrow biopsy or sending cytogenetic and molecular studies, I think what we’re seeing a lot and we’ve already realized as a community is that the molecular mutations really do need to be incorporated into the prognostication system for patients with MDS. I think it adds a lot of value, certainly for these patients to more accurately risk stratify them.