Transfusion-Dependent Patients With Lower-Risk MDS Receiving Luspatercept or Epoetin Alfa: Hb and QOL

Anemia often occurs due to myelodysplastic syndromes (MDS), causing increased fatigue, difficulty breathing, and decreased quality of life (QOL). When treating anemic patients with lower-risk MDS, the main objectives are to raise hemoglobin (Hb) levels and enhance QOL. Nevertheless, the specific Hb level required to significantly improve anemia symptoms and/or QOL, as reported by patients with MDS, remains uncertain.

This post hoc analysis investigated the correlation between Hb levels and QOL in red blood cell (RBC) transfusion-dependent individuals with lower-risk MDS who were initially treated with luspatercept or epoetin alfa.

The phase 3 COMMANDS randomized controlled trial analysis utilized patient-reported outcomes (PROs) and Hb levels. To gather data for the study, 2 PRO measures were employed: the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Core 30 (QLQ-C30) questionnaire, which was administered every 6 weeks, and the Functional Assessment of Cancer Therapy-Anemia (FACT-An) questionnaire, which was administered weekly for the first 3 weeks and every 3 weeks after that.

Hb levels were evaluated every 3 weeks or as determined necessary by the investigators. For this analysis, 7 anemia-related domain scores were chosen, including EORTC QLQ-C30 global health status/quality of life (GHS/QoL), physical functioning, fatigue (FA), dyspnea (DY), FACT-An fatigue subscale (FS), anemia subscale, and total score. Analyses were performed on the intent-to-treat population, combining data from all treatment arms.

Data up to week 37 were included in the analyses. Patients who were erythropoiesis-stimulating agent–naïve with lower-risk MDS who required RBC transfusions and were aged ≥18 years were included and randomized 1:1 to receive luspatercept (1.0 mg/kg every 3 weeks) or epoetin alfa (450 IU/kg every week).

The analysis included 356 patients, with 178 on luspatercept and 178 on epoetin alfa. At baseline, the patients had a mean age of 73.6 years and a median Hb level of 7.8 g/dL. An increase in Hb level was associated with a significant improvement in all PRO domains (P<.01). Patients with an Hb level increase of ≥1.5 g/dL showed a significantly more substantial improvement in all PRO domains compared with those with a change of <1.5 g/dL, reaching the clinically meaningful difference threshold for the DY domain.

Additionally, achieving an Hb level ≥10 g/dL was linked to significantly more significant improvement across all domains compared with reaching an Hb level <10 g/dL, with the difference exceeding the clinically significant difference for 3 domains (GHS/QoL, FA, and DY).

The findings of this analysis suggest that raising Hb levels is linked to a noteworthy enhancement in QOL. Achieving an Hb level ≥10 g/dL is more likely to significantly improve fatigue and dyspnea symptoms related to anemia and QOL, as measured by the QLQ-C30 questionnaire.

These findings will provide valuable insights for clinicians in determining the ideal Hb target for treating anemic patients with lower-risk MDS who require transfusion.

Source: Oliva E, Yucel A, Lord-Bessen J, et al. Relationship between hemoglobin and quality of life in transfusion-dependent patients with lower-risk myelodysplastic syndrome receiving luspatercept or epoetin alfa. Madrid, Spain, & online: presented at EHA2024 Hybrid Congress; abstract P774.