Optimizing Care for Lower-Risk Myelodysplastic Syndromes: Translating Evidence to Clinical Practice

Panelists discuss how myelodysplastic syndromes are diagnosed, classified, and managed, covering prevalence, symptoms, risk stratification tools, prognosis for lower-risk cases, and current treatment challenges.

Panelists discuss how risk stratification tools like IPSS-M are applied in practice for lower-risk myelodysplastic syndromes, addressing prognosis communication and current treatment challenges for this patient group.

Panelists discuss how they would approach initial assessment, treatment selection, and laboratory testing for a patient case, considering factors like symptoms and individual patient characteristics to guide first-line therapy decisions.

Panelists discuss how treatment goals for patients with lower-risk MDS are established and analyze the findings of Oliva et al’s study on the relationship between hemoglobin levels and quality of life in transfusion-dependent patients with lower-risk MDS treated with luspatercept or epoetin.

Panelists discuss how luspatercept’s mechanism of action, its first-line indication for patients with lower-risk MDS with ring sideroblasts, and the results of the COMMANDS trial support its use as an effective alternative to traditional erythropoiesis-stimulating agents, potentially changing the treatment landscape for transfusion-dependent patients with MDS.

Panelists discuss how they approach luspatercept dosing strategies in clinical practice; manage treatment-related adverse events such as fatigue, hypertension, and diarrhea; and monitor labs for signs of relapse, while also considering real-world dose escalation outcomes and the correlation between peripheral blood and bone marrow biopsy mutations in patients with MDS.

Panelists discuss how they determine thresholds for changing therapy in patients with MDS, evaluate second-line treatment options including the potential use of ESAs after luspatercept, and offer key takeaways for community colleagues managing similar clinical scenarios.

Panelists discuss how they would initially assess and approach treatment for this patient case, considering their clinical experience and practice patterns in managing similar scenarios.

Panelists discuss how luspatercept’s role in ring sideroblast–negative MDS populations is evolving based on recent clinical trial data, including the COMMANDS trial and PACE-MDS study, with particular attention to the impact ofEPO levels on treatment decisions and outcomes.

Panelists discuss how their clinical experience with ESA failure rates and timelines compares with reported outcomes in large community practice studies, and how they counsel patients on the choice between luspatercept and ESAs as first-line therapy for lower-risk MDS, incorporating patient preferences and patient-reported outcomes from recent clinical trials.

Panelists discuss how imetelstat, a telomerase inhibitor recently approved by the FDA on June 6, 2024, works and its efficacy as demonstrated in the IMerge trial, while highlighting key adverse events that community oncologists should be vigilant about when considering this treatment for patients with lower-risk MDS.

Panelists discuss how the treatment landscape for lower-risk MDS may evolve with emerging novel agents and combination strategies, including studies on luspatercept vs epoetin alfa, luspatercept combinations, elritercept, roxadustat, and canakinumab, potentially offering new options for patients with suboptimal responses to current therapies.

Panelists discuss how community oncologists can apply key takeaways from this clinical scenario in their practice, emphasizing the importance of collaborating with academic clinicians for optimal patient identification and treatment selection in the evolving landscape of lower-risk MDS management.