ASH 2024 | MDS highlights from ASH 2024

Yeah, so in myelodysplastic syndrome, I think ASH as usual had a number of very interesting abstracts. I would group them in the lower risk and in the higher risk. So in the lower risk disease, we have seen updates from the IMerge trial which looked at imetelstat in refractory relapsed MDS after ESA failure. And the focus of this abstract was on the activity of imetelstat after other therapies. So in the pivotal trial that led to the approval of the drug was done in patients after ESA failure. So we did not know how well does the drug work after luspatercept, after lenalidomide, HMAs. And what we could see clearly that the activity was there around 20 to 30 percent of patients will achieve transfusion independence. There was also a presentation on long-term follow-up from the luspatercept COMMANDS trial, which led to the approval of luspatercept in the frontline setting in patients with lower risk MDS and transfusion-dependent anemia. And presentations in ASH looked at long-term outcomes, the patients who had long-term responses, and to understand better the predictors of those long-term responses. So I think the data clearly demonstrate the continued benefit from using luspatercept in lower risk MDS. And then there was a number of actually interesting presentations looking at adding luspatercept as a backbone strategy to ESA. This was a French trial. Another French trial that looked at early versus late initiation of ESA. I think those trials were interesting but still early in their kind of life cycle. So I think we need to see additional results from those trials before we can make recommendations in terms of what community doctors do in kind of their day-to-day activity. And finally there was a number of presentations looking at higher risk MDS. One presentation from China looked at the addition of [INAUDIBLE] to a hypomethylating agent in the frontline setting. The results seem promising, but we need to see the details of the full trial. And there were a couple of presentations about the use of oral versions of hypomethylating agents, one called ASTX-030 and the other one is called the ASTX-727, an oral version of azacitidine, and an oral version of decitabine. And they seem both to mimic the IV or subcutaneous version. So I think the progress is still happening in MDS, and hopefully we are going to see additional data come in the next year.

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