Managing Adverse Events for Patients With MDS Given Imetelstat

Amer Zeidan, MBBS, chief of the Division of Hematologic Malignancies, director of Early Therapeutics Research and Leukemia and Myeloid Malignancies Program, and assistant medical director of the Clinical Trials Office at Yale Cancer Center, discusses common adverse events and toxicity management for imetelstat (Rytelo) in patients with myelodysplastic syndromes (MDS).

Zedian notes that although imetelstat is an effective treatment for anemia in transfusion-dependent, lower-risk MDS, its primary challenge is managing hematologic adverse events. Neutropenia and thrombocytopenia are common and often grade 3/4, but reversible with appropriate management strategies, including dose interruptions, delays, and reductions.

Close monitoring via weekly complete blood counts (CBCs) for the first 2 months is essential to mitigate risks, according to Zeidan. Supportive care such as platelet transfusions or growth factors may be needed. With vigilant management, imetelstat can be used without a significant increase in severe adverse events.

TRANSCRIPTION

0:10 | While imetelstat is very effective to treat anemia in patients with lower-risk MDS who are transfusion dependent, especially after [erythropoietin-stimulating agent] failure, the main adverse event is hematologic in the form of neutropenia and thrombocytopenia, which are common. They occur in around two-thirds of patients. They are generally severe with the grade 3 and grade 4. However, they are reversible with dose interruption and dose delays, basically, as well as dose reductions when needed.

0:45 | With good management, in the IMerge study [NCT02598661], this did not lead to an increase in severe hematologic toxicity, [or] consequences such as severe infections or severe bleeding, but it does require close monitoring. If the patient is started on the drug, per the label, they should get a CBC once a week for the first 2 months to monitor for thrombocytopenia and neutropenia. They might need, occasionally, some platelet transfusions, although it's uncommon, and they might need antibiotic prophylaxis for neutropenia, growth factor support, etc. So with all of this being done closely, the management is closer to what we do with azacitidine, so it's very important to effectively monitor and manage those patients.