Exploring Patient-Directed Care and Treatment Options for Patients With Myelodysplastic Syndromes
At the 2025 Great Debates (GD) in Hematologic Malignancies meeting in New York, New York, Aditi Shastri, MD, Montefiore Einstein Comprehensive Cancer Center, Bronx, New York, discussed insights into patient-directed care as well as newly approved treatment options and updated prognostic scoring systems for patients with myelodysplastic syndromes (MDS).
Transcript:
Hi, I am Aditi Shastri. I'm a faculty at the Montefiore Einstein Comprehensive Cancer Center, Department of Oncology in the Bronx, New York. Today at the Great Debates in Hematologic Malignancies, I spoke about myelodysplastic syndromes with a focus on patient-directed care and symptom management.
Since the past 5 years, we've had many advances in the treatment of MDS. Chiefly, we have a new prognostic scoring system, the IPSSM. We have several new drugs that have been FDA approved. We have an oral form of a hypomethylating agent, decitabine/cedazuridine. We have luspatercept, which is a drug approved in the first-line setting. We have imetelstat, another drug that has been approved for patients that have failed ESAs, or erythropoietin stimulating agents, or are ESA-refractory, so more available in the second-line setting.
I actually gave an update today on how we're using these drugs in the clinic and what sort of conversations to have with your patients when you're offering them these treatments, what side effects they could expect to have while they start seeing a benefit, which is chiefly an improvement in their anemia. To talk a little more in detail about that, I wanted to also say that just managing anemia and transfusion-dependency is a very important component of taking care of patients with MDS. Whether we do this with giving transfusion support or therapies, it's very important to address this because it's directly linked to overall survival that we see in our patients.
In addition to the drugs that I just mentioned, we have other drugs like lenalidomide, which is FDA-approved, and we use for treating patients with [chromosome] deletion 5q. This is a drug that we continue to use. I presented some new data from a Spanish study, the SINTRA-REV, where this drug was given to patients before they became transfusion-dependent, and it improved the time towards transfusion dependency. I also presented some data to show that if you discontinue the drug, patients who restart the treatment can achieve transfusion independence again.
I presented some updated data from the luspatercept, COMMANDS phase 3 study, which was just presented at the EHA meeting in Milan, Italy, which actually showed that there was a trend towards an improved survival on treatment with luspatercept compared to ESAs at the 2.5-year interval with a trend towards RBC transfusion independence at this time point as well.
I also just showed some data on the imetelstat study, the phase 3 IMerge, which actually showed that there was an improvement of transfusion independence at the 8-week time point, which was sustained through multiple time points thereafter. There may be a potential disease modifying effect of this drug, which we hope to see more and more in the future.
Eventually, there are some patients with low risk MDS that will need a bone marrow transplant. We went through a recent publication where a decision-making algorithm was made using artificial intelligence, and this helped us risk stratify better, which patients should go on to an allo-transplant. Specifically, patients with higher risk MDS did much better if they were prioritized for an allogeneic transplant and this was offered to them in a timely manner versus patients with lower risk transplant who have the luxury of waiting. This recaps what I discussed at the Great Debates today.
Source:
Shastri A. Enhancing Patient Care in Low- and Intermediate-Risk Myelodysplastic Syndromes: A Focus on Risk Stratification and Symptom Management. Presented at the Great Debates in Hematologic Malignancies meeting. June 28-29, New York, NY.
