Managing Luspatercept Toxicities and Determining When to Switch Therapy in Low-Risk MDS

Luspatercept has become an important option for patients with lower-risk myelodysplastic syndrome who have anemia, but appropriate monitoring and management of adverse effects are essential. Common toxicities include fatigue, headache, bone or musculoskeletal pain, hypertension, diarrhea, and injection-site reactions, most of which are low grade and manageable with supportive care, dose adjustments, or temporary treatment interruptions. Blood pressure monitoring and symptom assessment at regular visits are key to ensuring safe long-term use. Despite these measures, some patients may experience inadequate hematologic response or loss of response over time. In these cases, clinicians must reassess disease biology, transfusion burden, and patient goals. Transitioning to alternative therapies such as imetelstat may be considered for patients with persistent transfusion dependence or disease progression, emphasizing an individualized, response-driven treatment strategy.