MDS 2023 | Improving the treatment of low-risk MDS: luspatercept, treatment sequencing & disease classification

I think that in low-risk MDS there has been a lot of activity, mostly through some recent press releases and we await data actually in a few weeks at ASCO regarding luspatercept and imetelstat. But Luspatercept recently reported that the COMMANDS study was positive. What that means while we eagerly await the rest of the data, but hopefully this just adds to our arsenal of tools in lower risk MDS and timing of those tools. You know, really thinking about how do we optimize the schedule of treatments. I think that if we have a number of therapies that are effective in lower risk MDS, an important question coming up for the years ahead is which therapy should go, when? When should we start with a given therapy? When should we be rotating to a second line or a third line of therapy? That sequencing question I think is going to be really important as we get more tools in our arsenal. I think another major area that we need to think about and that we have improved on is our ability to classify people who have truly low risk disease, meaning that their disease is unlikely to progress over the coming years. And molecular diagnostics have really helped us better identify people who will live a long time with their MDS. Those are the patients for whom really sequencing and having more lower risk therapies is the most important. Similarly, people whose disease is going to progress, you need to think more about how to try to prevent that progression and maybe moving them out of this so-called lower risk cohort into a high, lower risk disease or something along those lines. So, for luspatercept, a great tool in our pockets right now, COMMANDS study will be a really rich data set for us to look at. Also, understanding its application outside of just second line ring sideroblast transfusion dependent patients. So I’m excited for June to find out.