Imetelstat and Luspatercept in MDS Anemia | Valeria Santini, MD | #EHA2025

Hi everybody, my name is Valeria Santini. I work at the University of Florence. I'm a haematologist taking care of myelodysplastic syndrome patients. So I'm here at the IHA 2025 meeting in Milan and I've been presenting several data and several options of therapy for myelodysplastic syndrome patients. What I think is quite interesting is the relevance of the treatment in patients who are lower risk MDS and transfusion dependent who received Luspater subq versus erythropoietin. Now these patients have a transfusion need that is ranging from two to six red blood cell units in the eight weeks and what is clear is that there is, of course, there is a higher response rate in terms of reaching transfusion independence, so stop transfusion for at least eight weeks in the patients who receive Luspater subq versus erythropoietin. But what is presented here is some new data and the data regarding overall survival. So we do not only care for quality of life but also for prolonging in good conditions the life of our patients. So when you give Luspater subq and you look in the long follow-up, so more than 2.5 years, you see that patients have an advantage in survival and if you just look at the patients who are still treated after three years, you see that this prolongation of survival versus Luspater subq versus erythropoietin is indeed significant and this is why I think that the sooner the transfusion dependent patients are treated, the better are the results. Regarding other options, there are several options. Now in this case we are talking about using Luspater subq immediately, not first receiving EPO but just immediate when a patient is transfusion dependent. But if the patient has already received EPO, then the options are Luspatercept or Imetastat. Luspatercept is a subq subcutaneous injection to receive every three weeks with a very small side effect, very well tolerated that can be escalated. The dose is starting at one and goes up to 1.75 if there is no response in this treatment. The other option is Imetastat that is an IV drug given every four weeks and the major side effect is that you may encounter neutropenia, so decrease in white blood cells and decrease in platelets that is transient and it goes up and the treatment can start it again. Both drugs are very effective in inducing transfusion independence, so freedom from transfusion for more than eight weeks and this is something extremely important for the quality of life of patients. So having that in mind, I think that we have several tools to improve the life and survival of our lower risk and patients who are anemic and transfusion dependent. And in the case of using Luspatercept in transfusion dependent patients who did not receive prior erythropoietin, you see that when you measure 12 weeks of freedom from transfusion plus an increase of 1.5 gramme hemoglobin, you really see a greater rate of response and transfusion independence. So I think it's very, very important and I think that both drugs are extremely active and can be suitable for a large part of our patients.