ASH 2025 | Long-term survival results from COMMANDS: luspatercept versus EPO in LR-MDS

We had a look at long-term survival in COMMANDS. The COMMANDS trial is a study that compares the efficacy of luspatercept to that of EPO in patients who have low-risk MDS and are transfusion dependent. And the primary endpoint, the primary objective is to verify after six months the achievement of transfusion independence, for longer than 12 weeks, plus an increase of hemoglobin of 1.5 grams per deciliter. And that’s something that is seen in 60% of cases so in comparison to 35% of patients treated with EPO. So having said so we analyzed in an oral communication that is given here at ASH 2025, we analyzed which were the patients who were more prone to respond. And what we saw is that indeed treating patients with the early characteristics of the disease, meaning higher hemoglobin level, of course, on the threshold of transfusion so below eight or over eight makes a big difference. So the patients with higher levels of hemoglobin who have a lower transfusion burden and who have a lower serum EPO level are the ones who are responding in a very high proportion of cases, nearly 80%, versus much lower cases, again, in EPO, but also compared to patients who have different characteristics of the disease. And this is also reflected in the duration of response. So the idea that we have is that if you treat early these transfusion-dependent patients, if you do not wait that the disease is too, let’s say, advanced, even not progressed, but advanced, you can obtain really outstanding results in terms of achievement of transfusion independence.

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