Opinion|Videos|July 11, 2025
Optimizing Luspatercept Therapy: Dosing Strategies and Treatment Response Management in Lower-Risk MDS
Author(s)Saeed Sadeghi, MD
A panelist highlights that after initial hemoglobin decline despite dose escalation, further increasing luspatercept dosing led to transfusion independence and hemoglobin improvement, underscoring the critical role of regular monitoring and timely dose adjustments to optimize anemia management in low-risk myelodysplastic syndrome.
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After several months of treatment, the patient’s hemoglobin had declined back to baseline levels around 8.3 g/dL, despite an increased dose of luspatercept to 1.33 mg/kg. However, following 2 doses administered every 3 weeks at this escalated level, the patient no longer required transfusions, and hemoglobin improved to 10.7 g/dL. This clinical improvement highlights the importance of dose adjustments in managing anemia effectively.
When considering dosing strategies, clinical trial protocols like the COMMANDS trial serve as valuable guides. The primary goals are to maintain transfusion independence and achieve a hemoglobin increase of at least 1.5 g/dL. If a patient’s hemoglobin drops or fails to improve adequately, dose escalation is warranted. Similarly, if transfusion requirements persist or return, increasing the dose can help restore hemoglobin levels and reduce transfusion dependence.
In practice, regular monitoring of hemoglobin levels and transfusion needs is essential to inform timely dose adjustments. This approach optimizes therapeutic response and helps maintain stable anemia control, improving overall patient outcomes.
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