Luspatercept Outcomes Superior to Epoetin Alfa for Lower-Risk MDS Anemia

The COMMANDS trial evaluated luspatercept for the treatment of anemia in patients with transfusion-dependent, lower-risk myelodysplastic syndromes (MDS) not previously exposed to erythropoiesis-stimulating agents (ESAs). Its data show outcomes produced by luspatercept are superior to those from epoetin alfa (EA) in this population. Findings were presented at the Twelfth Annual Meeting of the Society of Hematologic Oncology in Houston, Texas.

“More luspatercept versus EA patients achieved hemoglobin level improvements, reductions in transfusion burden and [red blood cell (RBC)] units transfused, and had durable RBC transfusion independence responses, supporting luspatercept use as the preferred treatment for ESA-naive patients with lower-risk-MDS-associated anemia,” wrote lead author Amer Zeidan, MBBS, of Yale Cancer Center in New Haven, Connecticut.

The participants enrolled from the patient population were adults who had disease with or without ring sideroblasts, less than 5% bone marrow blasts, and endogenous serum erythropoietin levels below 500 U/L. For a minimum of 24 weeks, 182 patients received luspatercept dosed at 1.0 to 1.75 mg/kg every three weeks and 181 received EA dosed at 450 to 1050 IU/kg weekly.

The percentage of patients who achieved a target of 50% or greater reduction in their RBC unit transfusion needs over a 12-week or longer period was 83% of patients receiving luspatercept and 66.9% of those receiving EA (P=.0002). The median duration of this reduction in the luspatercept group was 130 weeks while in the EA group was 77 weeks (P=.0004).

Regarding patients who required less than four RBC units per 8 weeks at baseline, 89% of patients who received luspatercept achieved the reduction target as compared with 73.9% of those receiving EA. For patients who required at least four RBC units per 8 weeks at baseline, 71.9% of patients on luspatercept and 55.7% of patients on EA attained the target. Luspatercept recipients also experienced a longer median time to their next RBC transfusion compared with EA recipients, at 155 days versus 42 days (P<.0001).

Hemoglobin increases of at least 1.5 g/dL were attained by 74.2% of luspatercept recipients as compared with 52.5% of EA recipients (P<.0001). Luspatercept recipients also saw a longer a cumulative duration of response episodes than did EA recipients, at 147.9 weeks versus 95.1 weeks (P=.0067).

Reference

Zeidan AM, Platzbecker U, Della Porta MG, et al. Clinical benefit of luspatercept treatment in transfusion-dependent (TD), erythropoiesis-stimulating agent (ESA)-naïve patients with very low-, low-, or intermediate-risk myelodysplastic syndromes (MDS) in the COMMANDS trial. Abstract #MDS-166. Presented at the Twelfth Annual Meeting of the Society of Hematologic Oncology. September 4-7, 2024; Houston, Texas.