Interpreting IMerge Subgroup Analyses and Managing Imetelstat Safety

The IMerge trial provided important insights into the efficacy of imetelstat across patients with varying serum erythropoietin (sEPO) levels, a clinically relevant factor in low-risk MDS. Analyses demonstrated that imetelstat can achieve meaningful and durable transfusion independence even in patients with higher sEPO levels, a population that often derives limited benefit from ESAs. This finding helps refine patient selection and supports the use of imetelstat in individuals with limited treatment options after ESA failure. As with any disease-modifying therapy, careful monitoring for adverse effects is essential. Common toxicities include cytopenias, particularly neutropenia and thrombocytopenia, as well as liver enzyme elevations. These events are typically managed through dose interruptions, modifications, and close laboratory monitoring. Understanding both efficacy across subgroups and safety management strategies is key to optimizing imetelstat use in clinical practice.