Dr Garcia-Manero on the Association Between Hemoglobin Levels and QOL in Lower-Risk MDS

Guillermo Garcia-Manero, MD, professor, chief, Section of Myelodysplastic Syndromes, deputy chair, Translational Research, fellowship program director, Department of Leukemia, Division of Cancer Medicine, chair, faculty senate, The University of Texas MD Anderson Cancer Center, discusses the relationship between hemoglobin and quality of life (QOL) in patients with lower-risk myelodysplastic syndrome (MDS), as evaluated in a post-hoc analysis of the phase 3 COMMANDS trial (NCT03682536).

In recent years, 3 new indications have emerged for patients with lower-risk MDS, 2 of which involve luspatercept, Garcia-Manero begins. He notes that the primary objective of these clinical trials was to improve hemoglobin levels. Accordingly, the question of whether achieving this can result in meaningful improvements in quality of life for patients remains unanswered, Garcia-Manero states.

A post-hoc analysis of COMMANDS was conducted to address this question, with findings presented by Esther Oliva, MD, at the 2024 EHA Congress, he details. The COMMANDS trial compared luspatercept to an erythropoiesis-stimulating agent (ESA) in patients with low-, very low-, or intermediate-risk MDS who were red blood cell transfusion-dependent (RBC-TD). Oliva used patient-reported outcomes (PRO) tools to assess various domains related to QOL and linked these to increases in hemoglobin, Garcia-Manero explains.

The analysis showed a strong correlation between higher hemoglobin levels and clinically significant improvements in QOL, particularly for those patients who achieved RBC independence (RBC-TI) and hemoglobin levels of 10 g/dL or higher, he reports. These patients reported better outcomes in key domains, including anemia-related symptoms and fatigue. Importantly, patients with an increase in hemoglobin of more than 1.5 g/dL, or those reaching a level above 10 g/dL, experienced more pronounced improvements, Garcia-Manero states.

These findings underscore the importance of targeting hemoglobin increases in clinical trials, as improving hemoglobin directly enhances patient well-being and QOL, which remains a central goal for clinicians treating lower-risk MDS, he concludes.