Patient Case Presentation: Patient Is RBC Transfusion Eligible—Would You Proceed to Transfusion or Initiate Long-Term Anemia Treatment Strategies?
Panelists discuss a complex case of lower-risk myelodysplastic syndrome in a patient with rheumatoid arthritis, debating immediate transfusion for symptom relief vs thorough evaluation and targeted long-term anemia management to balance comorbidities and optimize outcomes.
EP: 1.Early vs Late Onset of ESA in LR-MDS: Results From Phase 3 EPO-PRETAR Trial
EP: 2.COMMANDS and ELEMENT-MDS Trials: Long-Term Analysis, Survival, Duration of Response, and Hemoglobin Levels
EP: 3.IMerge Trial
EP: 4.Debate: Optimal Initiation of ESAs, Luspatercept, and Imetelstat: Pretransfusion vs Posttransfusion
EP: 5.Debate: Inflection Point for LR-MDS Therapy: Serum EPO >200 U/L vs Serum EPO >500 U/L
EP: 6.Debate: Sequencing Therapies for LR-MDS: ESA First vs Luspatercept First
EP: 7.Patient Case Presentation: Patient Is RBC Transfusion Eligible—Would You Proceed to Transfusion or Initiate Long-Term Anemia Treatment Strategies?
EP: 8.Patient Case Presentation: Patient on ESA for First-Line Therapy and Not Receiving a Marked Response—What Do You Do Next, and Why?
The case presented involved a 71-year-old man with a history of rheumatoid arthritis and mild macrocytic anemia, who over several years experienced worsening fatigue and declining hemoglobin levels, ultimately diagnosed with lower-risk myelodysplastic syndrome (MDS). Initial lab work showed moderate anemia and stable platelet counts, but by early 2025, his hemoglobin had dropped significantly. Despite the diagnosis of MDS with a low-risk score, the patient remained symptomatic but transfusion naive. The question posed was whether to initiate transfusions immediately or pursue longer-term anemia treatment strategies.
One perspective favored starting with a transfusion to provide immediate symptom relief, followed by initiation of a disease-specific agent like luspatercept, particularly given the patient’s negative erythropoietin status and autoimmune background. This approach balances symptom control with a goal of achieving transfusion independence over time. The other viewpoint emphasized the need to consider additional causes of anemia, including the impact of rheumatoid arthritis and its treatment. Thorough reassessment of vitamin and mineral levels such as B12, folate, and copper was recommended before finalizing treatment, as these deficiencies can contribute to cytopenias and may be overlooked. Moreover, the role of inflammation and potential immunosuppressive therapies was also discussed, especially since the diagnosis was based on marrow morphology and limited genetic data.
The debate underscored the complexity of managing anemia in patients with comorbid autoimmune disease and MDS. It highlighted the importance of a comprehensive workup to rule out reversible causes and careful interpretation of genetic findings. Ultimately, this discussion reinforced that treatment decisions in such cases require balancing immediate symptom relief, long-term disease control, and addressing comorbid conditions. This nuanced approach aims to optimize patient outcomes in the face of overlapping clinical factors.
