Blood cancers, it is possible to decrease transfusions

Independence from transfusions for a long period of time. An important target for those with myelodysplastic syndromes (MDS) who have developed anemia. This is the result obtained with luspatercept, a molecule that promotes the maturation of red blood cells; a superior result to those obtained by treating them with epoetin alfa, an erythropoiesis stimulating agent (ESA). The study demonstrating this will be presented at the Congress of the American Society of Clinical Oncology (ASCO) which will take place in Chicago from 2 to 6 June.

“Chronic anemia, low hemoglobin levels, and transfusion dependency pose major clinical challenges for low-risk MDS patients and increase the risk of death by more than half of patients compared with those who do not require transfusions,” says Guillermo Garcia-Manero, principal investigator and director of the Section of Myelodysplastic Syndromes at the University of Texas MD Anderson Cancer Center. “Results from the COMMANDS study showed that treatment with luspatercept, compared with epoetin alfa, produced statistically significant higher rates of red blood cell transfusion independence and increased hemoglobin, improved response duration, with outcomes equal to or better than in all subgroups, and with acceptable safety and tolerability for ESA-naïve low-risk myelodysplastic syndromes patients.

Blood cancers

Myelodysplastic syndromes are a group of closely related blood cancers characterized by ineffective production of healthy red blood cells, white blood cells, and platelets, which can cause anemia and frequent or severe infections. People with MDS who develop anemia often need regular blood transfusions to increase the number of healthy red blood cells in circulation. Frequent transfusions are associated with an increased risk of iron overload, transfusion reactions, and infections. Patients who become dependent on red blood cell transfusions have significantly shorter overall survival than those who are not transfusion dependent, in part due to iron overload or more severe bone marrow disease than that of non-transfusion dependent patients. transfusions.

“Clinical experience has shown that only one in three patients with low-risk myelodysplastic syndrome show responses to erythroid-stimulating agents over 6-18 months, confirming a significant need for more effective options to address chronic anemia,” says Matteo Giovanni Della Porta, study investigator and director of the Leukemia Unit at the Humanitas Cancer Center in Milan, Italy. “In the COMMANDS study, the median duration of red blood cell transfusion independence was approximately one year longer with luspatercept compared to epoetin alfa, and luspatercept showed a safety profile consistent with that already known, demonstrating its potential as a first-line treatment in patients with very low-to-intermediate-risk, transfusion-dependent MDS.

I study

The COMMANDS clinical study included 354 people who had low-risk MDS and needed red blood cell transfusions to treat anemia. Participants in this study had not previously received treatment with an ESA and were divided into two groups: 178 received luspatercept by injection once every 3 weeks for at least 24 weeks and 176 received epoetin alfa (an ESA) by injection once a week for at least 24 weeks. The study aimed to evaluate transfusion independence for 12 weeks or longer with a concomitant mean hemoglobin increase of ≥1.5 g/dL within the first 24 weeks of treatment. At the time of the planned interim data analysis presented at the Asco meeting, 58.5% of people receiving luspatercept had achieved this goal, compared with 31.2% of those receiving epoetin alfa. The other study objectives included measures of the amount of hemoglobin in the blood and the likelihood of developing less transfusion dependence or requiring fewer transfusions. For all of these indicators, luspatercept was more effective than epoetin alfa. “Luspatercept has the potential to change clinical practice and be used as the first treatment instead of ESAs. Patients will have to go to the Centers less often and receive blood transfusions less frequently. They will benefit from a better quality of life and better health conditions,” concluded Garcia-Manero.