Abstracts Clinical Lymphoma, Myeloma & Leukemia September 2023 S358 allogeneic stem cell transplantation (alloSCT), with a 2-year median OS after alloSCT of 85%. Conclusions: Most patients with MDS with DDX41 mutations have a germline and a somatic mutation. Normal karyotype is a common finding in these patients, and, in our cohort, ASXL1 and TP53 were the most frequent co-mutations. Response rates were high, and OS was improved in patients receiving venetoclax, although not statistically significative. Outcomes appear favorable with alloSCT. Keywords: MDS, DDX41, venetoclax MDS-225 The Long‑Term Efficacy of Erythropoiesis‑Stimulating Agents in Patients With Low‑Risk or Intermediate‑1‑Risk Myelodysplastic Syndrome: Multicenter Real‑Life Data Müzeyyen Aslaner Ak MD1, Ayfer Gedük MD2, İbrahim Halil Açar MD3, Merve Gökçen Polat MD2, Cenk Sunu MD4, Ali Zahit Bolaman MD5, Tuğba Hacıbekiroğlu MD4, Birol Güvenç MD3, Şehmus Ertop MD1 1Zonguldak Bulent Ecevit University Faculty of Medicine, Zonguldak, Turkey. 2Kocaeli University Faculty of Medicine, Kocaeli, Turkey. 3Çukurova University Faculty of Medicine, Adana, Turkey. 4Sakarya Training and Research Hospital, Sakarya, Turkey. 5Adnan Menderes University Faculty of Medicine, Aydın, Turkey Objective: To evaluate the long-term clinical efficacy of epoetin alfa and darbepoetin alfa in patients with myelodysplastic syndromes (MDS) in the real-life setting. Methodology: A total of 204 patients with low-risk or intermediate-1-risk MDS who received epoetin alfa or darbepoetin alfa were included. Hemoglobin levels and transfusion-need were recorded before and during 12-month, 24-month, 36-month and 48-month treatment. Results: At 36-month (P=0.025) and 48-month (P=0.022) visits, epoetin alfa vs darbepoetin alfa yielded significantly higher hemoglobin levels. Transfusion-need was also significantly lower in epoetin alfa vs darbepoetin alfa groups at 24-month (P=0.012), and in low risk vs intermediate risk groups at 24-month (P=0.018), 36-month (P=0.025) and 48-month (P<0.001) visits. Treatment response rates at 24-month, 36-month and 48-month visits in epoetin alfa (43.0, 33.6 and 27.1%), darbepoetin alfa (29.9, 22.7 and 16.5%), low risk (39.3, 30.0 and 26.0%) and intermediate risk (29.6, 24.1 and 11.1%) groups were lower than 12-month response rates, significantly at 36-month and 48-month visits (P ranged <0.05 to <0.001). Conclusion: This real-life long-term ESA extension study investigated the clinical efficacy of epoetin alfa and darbepoetin alfa for up to 48 months and revealed the treatment efficacy to reach plateau starting from the 24th month of therapy with a continuing decrease in treatment response rates, regardless of treatment type, risk status or gender. Nonetheless, significantly higher hemoglobin levels and marked improvement in transfusion-need was evident in the epoetin-treated vs darbepoetin-treated groups and in the lowrisk vs intermediate risk groups. Keywords: MDS, myelodysplastic syndrome, darbepoetin alfa, duration of response, epoetin alfa, long-term, low-risk- intermediate-1–risk, transfusion dependence, treatment response MDS-234 Reduction of Transfusion Burden (TB), Hemoglobin Increase, and Dose Titration in the COMMANDS Study of Luspatercept Versus Epoetin Alfa (EA) in Erythropoietin‑Stimulating Agent (ESA)‑Naive Patients With Transfusion‑Dependent (TD) Lower‑Risk Myelodysplastic Syndromes (LR‑MDS) Rami S. Komrokji MD1, Uwe Platzbecker MD2, Matteo Della Porta MD3,4, Valeria Santini MD5, Guillermo GarciaManero MD6, Jiahui Li PhD7, Jennie Zhang MSc7, Ana Carolina Giuseppi MD7, Sandra Kreitz PhD8, Veronika Pozharskaya MD, PhD7, Karen L. Keeperman MPA7, Shelonitda Rose MD7, Christina Hughes PhD7, David Valcárcel MD9, Pierre Fenaux MD, PhD10, Jake Shortt PhD11 1Moffitt Cancer Center, Tampa, FL, USA. 2Department for Hematology, Cell Hematology and Hemostaseology, Leipzig, Germany. 3Cancer Center IRCCS Humanitas Research Hospital, Milan, Italy. 4Department of Biomedical Sciences, Humanitas University, Milan, Italy. 5MDS Unit, Hematology, University of Florence, AOUC, Florence, Italy. 6Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 7Bristol Myers Squibb, Princeton, NJ, USA. 8Celgene International Sàrl, a Bristol-Myers Squibb Company, Boudry, Switzerland. 9Hospital Universitari Vall d’Hebron, Barcelona, Spain. 10Service d’Hématologie Séniors, Hôpital SaintLouis, Université Paris 7, Paris, France. 11Monash University and Monash Health, Melbourne, VIC, Australia Context: The COMMANDS study (NCT03682536) demonstrated durable RBC transfusion independence (RBC-TI) improvements with luspatercept versus EA in ESA-naive patients with TD LR-MDS. Objective: Report additional benefits in hemoglobin increase ≥1.5 g/dL, RBC-TI ≥12 weeks, TB reduction, and luspatercept dosing from COMMANDS. Patients: Eligible patients were ≥18 years, TD, with serum erythropoietin <500 U/L. Interventions: Patients received subcutaneous luspatercept (1.0–1.75 mg/kg; Q3W) or EA (450–1050 IU/kg; Q1W) for ≥24 weeks. Main Outcome Measures: Primary endpoint was RBC-TI ≥12 weeks with concurrent mean hemoglobin increase ≥1.5 g/dL (weeks 1–24). Additional endpoints included response, duration of response, and TB reduction. Results: 178 patients were randomized to luspatercept and 178 to EA (per 31Aug2022). In this preplanned interim analysis with 301 patients, 86/147 (58.5%) luspatercept and 48/154 (31.2%) EA patients achieved the primary endpoint (P<0.0001). Greater proportions of luspatercept than EA patients achieved mean hemoglobin increase ≥1.5 g/dL (106 [72.1%] vs 75 [48.7%] patients; P<0.0001; weeks 1–24) and RBC-TI ≥12 weeks (98 [66.7%] vs 71 [46.1%] patients; P=0.0002; week 1 to EOT). Median duration of longest hemoglobin increase ≥1.5 g/dL, and median duration of RBC-TI ≥12 weeks, was longer with luspatercept than EA (77.9 vs 55.6 weeks, 126.6 vs 77.0 weeks, respectively). A greater proportion of luspatercept than EA patients achieved ≥50% reduction in pRBC units ≥12 weeks (120 [81.6%] vs 101 [65.6%]; P=0.0016). Median (95% CI) duration of TB reduction was 130.0
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