Abstracts Clinical Lymphoma, Myeloma & Leukemia September 2023 S354 peripheral blood. BM mononuclear cells (BMMC) were subjected to bulk RNA sequencing. Serum ERFE, GDF11, hepcidin, and GDF15 were measured by ELISA. Results: Compared with baseline, EPs increased in the luspatercept arm at week 24 (P=0.031) and 48 (P=0.000017), as did reticulocytes (P<0.0001). EPs increased for EA at week 24 (P=0.0017), but reticulocytes were unchanged. There was a sustained increase in EPs and reticulocytes at week 48 with luspatercept (P<0.001), but not with EA (P=0.056 and P=0.67, respectively). Median ERFE levels increased significantly at week 24 in both treatment arms (luspatercept: 7.2 vs 10.1 ng/mL; P<0.05; EA: 9.1 vs 10.4 ng/mL; not significant) as did GDF15 (luspatercept: 5.0 vs 7.0 ng/mL; EA: 4.5 vs 5.4 ng/mL; P<0.05). Gene set enrichment analysis on BMMC revealed enrichment of early-, mid-, and late-EP genes at baseline favored response to luspatercept, whereas enrichment of mid- and late-EP genes was unfavorable for EA. Luspatercept downregulated TGFb, IL-6, apoptosis, and spliceosome pathways. Conclusions: Compared with EA, response to luspatercept increased EPs and reticulocytes over 48 weeks with concomitant hemoglobin increase. Unlike EAs, luspatercept acts on different erythroid stages, leading to expansion and maturation of EPs, for superior clinical benefit. These novel insights mechanistically differentiate the superior clinical benefit of luspatercept in patients with LR-MDS from EA. Acknowledgement: This study was funded by Bristol Myers Squibb. Abstract was accepted at EHA 2023 (Platzbecker U, et al. HemaSphere. 2023;7[S3]. Abstract P693). Keywords: myelodysplastic syndromes, anemia, erythropoiesis, erythroid differentiation, phase III MDS-143 Characteristics and Outcomes of Myelodysplastic Syndrome Patients Treated With Darbepoetin Alfa for Anemia in Turkey: A Multicenter Retrospective Study İbrahim Halil Açar MD1, Figen Atalay MD2, Esra Terzi Demirsoy MD3, Ferda Can MD4, Zeynep Tuğba Güven MD5, Mustafa Çetiner MD6, Anıl Tombak MD7, Melda Cömert MD8, Birol Güvenç MD1 1Çukurova University, Faculty of Medicine, Department of Internal Medicine, Department of Hematology, Adana, Turkey. 2Baskent University, Istanbul Hospital, Hematology Clinic, Ankara, Turkey. 3SBU Kocaeli Derince Training and Research Hospital, Hematology Clinic, Kocaeli, Turkey. 4Ankara City Hospital, Hematology Clinic, Ankara, Turkey. 5Erciyes University Faculty of Medicine, Department of Internal Medicine, Department of Hematology, Kayseri, Turkey. 6Acıbadem Maslak Hospital, Hematology Clinic, Istanbul, Turkey. 7Mersin University Faculty of Medicine, Department of Internal Medicine, Department of Hematology, Mersin, Turkey. 8SBU Gulhane Training and Research Hospital, Hematology Clinic, Istanbul, Turkey Background: Myelodysplastic syndrome (MDS) is a clonal, heterogeneous stem cell disease, usually seen in advanced age, with cytopenia as a result of ineffective hematopoiesis. Anemia is a common complication in MDS patients, significantly impacting quality of life and increasing morbidity. Darbepoetin alfa (DA) is an erythropoiesis-stimulating agent (ESA) that has shown promising results in treating anemia in MDS patients. Aim of Study: This study aims to describe the demographic, clinical, and laboratory characteristics of MDS patients in Turkey and to evaluate the efficacy, safety, and optimal dosing strategies of DA in the management of anemia in this population. Methodology: A retrospective multicenter observational cohort study was conducted, focusing on data collected between 2015 and 2021 from 8 different centers in Turkey. Data were collected and analyzed from 226 MDS patients at very-low, low, or intermediate-risk, according to IPSS-R score, who were receiving DA treatment. Results: DA effectively managed anemia in MDS patients, reducing the need for blood transfusions, with a significant decrease in transfusion units in the 4th, 8th, and 12th months of treatment (P<0.05). Headache (10.1%, n=23), hypertension (6.6%, n=15), thromboembolic event (3.6%, n=8) and peripheral edema (4%, n=9) were the main adverse events after DA use. The adverse event profile observed was consistent with previous studies evaluating the safety of DA. The 5-year survival rate was determined as 29.6% and 5-year survival rate observed were comparable to other studies evaluating the survival outcomes of MDS patients receiving ESAs, including DA. Conclusion: This study provides valuable insights into the demographic, clinical, and laboratory characteristics of MDS patients in Turkey, as well as the efficacy and safety of DA treatment for anemia. DA is an effective and safe treatment option to correct anemia in non–high-risk MDS patients. Keywords: MDS, myelodysplastic syndrome, darbepoetin alfa MDS-145 A Successful Treatment of Relapsed/ Refractory MDS Patient who is Followed Under Hemodialysis Bahar Sevgili MD1, Tural Pashayev MD2, Nur Soyer MD1, Filiz Vural MD1, Güray Saydam MD1 1Ege University, Faculty of Medicine, Department of Hematology, Izmir, Turkey. 2Liv Bona Dea Hospital, Department of Hematology, Baku, Azerbaijan Objective: This case report aims to present the successful treatment of a relapsed/refractory (R/R) myelodysplastic neoplasms (MDS) patient who was ineligible for allogeneic stem cell transplantation. We explore the use of azacitidine in combination with venetoclax as a potential therapeutic approach for MDS patients undergoing hemodialysis. Case: A 48-year-old female patient with symptomatic anemia refractory to erythropoietin stimulating agents (ESAs) presented to our hematology clinic. Initial laboratory findings indicated normocytic normochromic anemia and mild thrombocytopenia. Bone marrow biopsy confirmed MDS with excess blasts (EB-1) accounting for 6–7% of cells. After 6 cycles of standard dose azacitidine, bone marrow biopsy revealed MDS-EB-1 with 7–8% blast cells. Second-line treatment with decitabine was initiated but transfusion dependency worsened. As a third-line therapy, the patient received azacitidine in combination with venetoclax for 6 cycles. Venetoclax dose was adjusted due to persistent transfusion dependency, and after the third cycle, the
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