90+ y.o old male with recurrent admission for CHF, Hb 7 range. Bone marrow showed MDS/MPN vs MDS with increased blasts, 90% cellular, 5-6% blasts, atypical megs, 10% ring sideroblasts, 30% monocytes. FISH/cytogenetics normal but NGS: JAK2V617F, TET2 and ZRSR2. I had started him on luspatercept before receiving NGS and he has responded nicely with Hb up to 11.4. Is that ok to continue given his age and that anemia was most bothersome symptom? I am going to check his spleen size but he does not report symptoms related to that. Change to momelotinib?
Great question and idea. Luspatercept is a great choice and it seems to be working well at this time. I don’t think I’d stop or add in anything unless his counts worsen, Dz evolves, or develops new Sx. Based on his age unless he has a fantastic PS I’d likely be hesitant to switch to HMA. Momelotinib would be a great idea for the second line, though honestly to the best of my knowledge there’s no data on its use in this patient population. I think the company is planning trials in this exact pt population space
