Dr Sekeres on Using MDS Risk-Stratification Systems in Clinical Practice

Mikkael A. Sekeres, MD, MS, professor, medicine, chief, Division of Hematology, Leukemia Section, the University of Miami Health System and Sylvester Comprehensive Cancer Center, discusses the utility of myelodysplastic syndromes (MDS) risk-stratification systems.

At a recent OncLive® State of the Science Summit™ on hematologic malignancies, Sekeres and colleagues provided updates in the realm of MDS. The recent updates to MDS risk-stratification systems have had notable implications for treatment selection within this domain, as highlighted in the meeting, Sekeres begins. Various abstracts presented at the 2023 ASH Annual Meeting scrutinized different classification systems and assessed the accuracy of the IPSS-Molecular (IPSS-M) model in predicting outcomes. Initially, either the IPSS-revised or the IPSS-M stratification systems are employed to stratify patients into lower-risk or higher-risk MDS categories, Sekeres explains, thereby guiding treatment urgency and therapeutic options.

In terms of therapeutic advancements in MDS, recent clinical data have shed light on luspatercept-aamt (Reblozyl), Sekeres continues. Originally FDA approved for patients exhibiting ring sideroblasts linked with MDS post-exposure to an erythropoiesis stimulating agent (ESA), luspatercept demonstrated promising results in the phase 3 MEDALIST trial (NCT02631070), he reports. Further insights emerged from the phase 3 COMMANDS trial (NCT03682536), which compared upfront luspatercept with ESAs in patients with anemia due to lower-risk MDS who require red blood cell (RBC) transfusions, Sekeres elucidates. Results revealed significantly improved response rates and prolonged response durations with luspatercept, particularly among patients with ring sideroblasts or the SF3B1 mutation, prompting consideration of luspatercept as a first-line option or as subsequent therapy following ESA progression in these patient subsets, he notes.

Furthermore, findings from the phase 2/3 IMerge trial (NCT02598661) demonstrated substantial rates of RBC transfusion independence among patients receiving imetelstat compared with placebo recipients, he states. The imminent FDA decision on imetelstat's approval, anticipated in 2024, holds potential to introduce another treatment avenue for patients with lower-risk MDS, Sekeres concludes.