Craig Eckfeldt, MD, PhD, discusses the current treatment paradigm in MDS and the unmet needs in different subsets of patients.

Dr Eckfeldt on the Treatment Paradigm and Current Challenges in MDS

“For lower-risk MDS, [agents] like luspatercept certainly has provided a whole new avenue of treatments in a situation where traditional therapies like erythropoietin may not have been as effective [for MDS-related anemia]. Some of the molecular markers [used] to guide decision-making have been a major advance.”

Craig Eckfeldt, MD, PhD, assistant professor of medicine, faculty, Microbiology, Immunology, and Cancer Biology, PhD Graduate Program, Division of Hematology, Oncology, and Transplantation, Masonic Cancer Center, the University of Minnesota Medical School, discusses the current treatment paradigm and persistent unmet needs in the myelodysplastic syndrome (MDS) landscape.

® State of the Science Summit on hematologic malignancies, Eckfeldt and colleagues discussed changes in care for MDS and acute myeloid leukemia, highlighting the current treatment paradigm for MDS.

Over time, better understanding the pathophysiology of MDS has opened the door to developing new therapies that can specifically target cancer-driving factors, Eckfeldt explains. For lower-risk MDS, he notes that frontline treatment with luspatercept-aamt (Reblozyl) has provided a new option in the landscape; in August 2023, 

 for the treatment of anemia without prior erythropoiesis-stimulating agent use in adult patients with very low– to intermediate-risk MDS who may require regular red blood cell transfusions. The approval has provided a new option in a setting where other treatments, such as erythropoietin, have not been as effective in treating MDS-related anemia, he notes. Additionally, Eckfeldt says that identifying the molecular markers that can help guide decision-making has made a significant difference in advancing care for MDS.

However, unmet needs persist in MDS, especially within specific subsets of patients, Eckfeldt emphasizes, noting that a lot is unknown for patients with poor prognostic markers. Previous research has demonstrated specific patient populations who may not respond as well to treatment, but there’s still a need to change the treatment trajectory and outcomes for these patients, he says.

Although there are new therapies and investigational agents displaying encouraging data, subsets of patients with MDS, such as those harboring 

 mutations, still face treatment disparities, he notes. In the coming years, more meaningful or new approaches could help close the gap with these disparities in MDS, Eckfeldt concludes.

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Dr Eckfeldt on the Implications of Improved MRD Testing in AML

Craig Eckfeldt, MD, PhD, assistant professor, medicine, faculty, Microbiology, Immunology, and Cancer Biology PhD Graduate Program, Division of Hematology, Oncology, and Transplantation, the University of Minnesota Medical School, discusses how improved minimal residual disease (MRD) testing methods have impacted the acute myeloid leukemia (AML) treatment paradigm, improved treatment outcomes, clarified risk-stratification measures, and contributed to individualized patient care.

 State of the Science Summit on hematologic malignancies, Eckfeldt and colleagues participated in a discussion about 

the evolution of the AML treatment paradigm

, during which they reflected on emerging agents, the role of MRD testing, and unanswered questions that future research may address.

The advent of MRD detection is significantly impacting the management of hematologic malignancies, as well as other cancers, Eckfeldt begins. In the treatment of patients with acute lymphoblastic leukemia, MRD detection has become crucial for prognostication and guiding treatment goals, he says. Although the application of MRD testing in AML has lagged comparatively, modern technologies, such as improved multiparameter flow cytometry and advanced genetic tests like polymerase chain reaction–based assays, have made MRD an important end point when evaluating new AML treatment approaches, he explains.

MRD detection has proven valuable both before and after transplantation, aiding treatment decisions for patients who may have traditionally been considered to have favorable-risk disease, Eckfeldt elaborates. Although many patients achieve their therapeutic goals, some still relapse, he notes. The use of MRD testing to identify patients who are at higher risk of relapse and may benefit from more intensive treatments or novel therapies has revolutionized patient care, he emphasizes. The expanding repertoire of markers for MRD evaluation will further enhance the utility of MRD as a critical tool for assessing disease status and guiding clinical decisions. This will ultimately improve patient outcomes by enabling better risk stratification and personalization of treatment plans, Eckfeldt concludes.

Craig Eckfeldt, MD, PhD, discusses how improved minimal residual disease testing methods have impacted the acute myeloid leukemia treatment paradigm.

Craig Eckfeldt, MD, PhD

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Dr Eckfeldt on the Treatment Paradigm and Current Challenges in MDS

Dr Eckfeldt on the Implications of Improved MRD Testing in AML