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REBLOZYL® (luspatercept-aamt) logo
LR-MDS (FIRST-LINE) LR-MDS-RS (SECOND-LINE) BETA-THALASSEMIA

This website is intended for US Healthcare Professionals.

REBLOZYL® (luspatercept-aamt) logo
INDICATIONS

INDICATIONS

REBLOZYL® (luspatercept-aamt) is indicated for the treatment of anemia in adult patients with beta thalassemia who require regular red blood cell (RBC) transfusions.

REBLOZYL® (luspatercept-aamt) is indicated for the treatment of anemia without previous erythropoiesis stimulating agent use (ESA-naïve) in adult patients with very low- to intermediate-risk myelodysplastic syndromes (MDS) who may require regular red blood cell (RBC) transfusions.

REBLOZYL® (luspatercept-aamt) is indicated for the treatment of anemia failing an erythropoiesis stimulating agent and requiring 2 or more red blood cell (RBC) units over 8 weeks in adult patients with very low- to intermediate-risk myelodysplastic syndromes with ring sideroblasts (MDS-RS) or with myelodysplastic/myeloproliferative neoplasm with ring sideroblasts and thrombocytosis (MDS/MPN-RS-T).

REBLOZYL is not indicated for use as a substitute for RBC transfusions in patients who require immediate correction of anemia.

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DOSING AND ADMINISTRATION: REBLOZYL DOSING FOR ESA-NAIVE MDS PATIENTS

Dose-adjust to optimize patient response1

Nearly all patients required dose adjustments in the COMMANDS clinical trial2

Set expectations with your patients that their dose will likely be changed2

EXPECT response1

Per the COMMANDS trial, response is defined as:

  • Increased hemoglobin ≥1.5 g/dL from baseline
    AND
  • Transfusion independence ≥12 weeks
  • Response was achieved in 58.8% of patients in the REBLOZYL group and 31.2% of patients in the epoetin alfa group*
next arrow icon

EVALUATE response1

  • Before each dose, check for response and tolerability
  • Check hemoglobin before every administration
  • If transfusion occurred, check pretransfusion hemoglobin
next arrow icon

ESCALATE to achieve or regain response1,2

  • 80% of all patients receiving REBLOZYL had their dose increased at least once in COMMANDS
  • Interrupt or reduce the dose as needed for rapid hemoglobin rise or adverse reactions (see dosing modifications)†

58% (n=86/147); 95% Cl: 50.1, 66.6) of patients in the REBLOZYL treatment group and 31.2% (n=48/154; 95% CI: 24.0, 39.1) of patients in the epoetin alfa treatment group achieved RBC-TI with Hgb increase during Weeks 1 to 24.1

Discontinue REBLOZYL if a patient does not experience a decrease in transfusion burden including no increase from baseline Hgb after 9 weeks of treatment (administration of 3 doses) at the maximum dose level (1.75 mg/kg), or if unacceptable toxicity occurs at any time.1

Dose escalate to achieve or regain a response1

Callout DotsCallout Dots

80% of all COMMANDS patients receiving REBLOZYL
had their dose increased at least once2

Callout DotsCallout Dots
Dose titrations for esa-naïve patients on Reblozyl for MDSDose titrations for esa-naïve patients on Reblozyl for MDS

NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.

Do not increase dose more frequently than every 6 weeks (2 doses); do not increase dose beyond maximum dose.1

In the absence of transfusion, if predose Hgb is ≥11.5 g/dL or if Hgb increases >2 g/dL within 3 weeks, interrupt or decrease dose. See instructions for dosing modifications.1

For patients with IPSS-R very low-, low-, or intermediate-risk MDS non-del(5q) ± other cytogenetic abnormalities and RS <15% (or RS <5% with an SF3B1 mutation) with sEPO ≤500 mU/mL.3

Some patients in COMMANDS required a treatment interruption or dose reduction

For super-responders with predose hemoglobin ≥11.5 g/dL or rapid hemoglobin rise1:

SCENARIO REBLOZYL
Dosing recommendation
Predose Hgb is ≥11.5 g/dL in the absence of transfusions
  • Interrupt treatment
  • Restart when the Hgb is no more than 11 g/dL
Increase in Hgb >2 g/dL within 3 weeks in the absence of transfusions and:
Current dose is 1.75 mg/kg
  • Reduce dose to 1.33 mg/kg
Current dose is 1.33 mg/kg
  • Reduce dose to 1 mg/kg
Current dose is
1 mg/kg
  • Reduce dose to 0.8 mg/kg
Current dose is
0.8 mg/kg
  • Reduce dose to 0.6 mg/kg
Current dose is
0.6 mg/kg
  • Discontinue treatment

For adverse reactions1:

SCENARIO REBLOZYL
Dosing recommendation
Grade 3 or 4 hypersensitivity reactions#
  • Discontinue treatment
Other Grade 3 or 4 adverse reactions#
  • Interrupt treatment
  • When the adverse reaction resolves to no more than Grade 1, restart treatment at the next lower dose level||
  • If the dose delay is >12 consecutive weeks, discontinue treatment

Grade 1 is mild, Grade 2 is moderate, Grade 3 is severe, and Grade 4 is life threatening.

Per dose reductions in table above.

DOSING AND ADMINISTRATION: REBLOZYL DOSING FOR ESA-NAIVE MDS PATIENTS

Dose-adjust to optimize patient response1

Nearly all patients required dose adjustments in the COMMANDS clinical trial2

Set expectations with your patients that their dose will likely be changed2

EXPECT response1

Per the COMMANDS trial, response is defined as:

  • Increased hemoglobin ≥1.5 g/dL from baseline
    AND
  • Transfusion independence ≥12 weeks
  • Response was achieved in 58.8% of patients in the REBLOZYL group and 31.2% of patients in the epoetin alfa group*
next arrow icon

EVALUATE response1

  • Before each dose, check for response and tolerability
  • Check hemoglobin before every administration
  • If transfusion occurred, check pretransfusion hemoglobin
next arrow icon

ESCALATE to achieve or regain response1,2

  • 80% of all patients receiving REBLOZYL had their dose increased at least once in COMMANDS
  • Interrupt or reduce the dose as needed for rapid hemoglobin rise or adverse reactions (see dosing modifications)†

58% (n=86/147); 95% Cl: 50.1, 66.6) of patients in the REBLOZYL treatment group and 31.2% (n=48/154; 95% CI: 24.0, 39.1) of patients in the epoetin alfa treatment group achieved RBC-TI with Hgb increase during Weeks 1 to 24.1

Discontinue REBLOZYL if a patient does not experience a decrease in transfusion burden including no increase from baseline Hgb after 9 weeks of treatment (administration of 3 doses) at the maximum dose level (1.75 mg/kg), or if unacceptable toxicity occurs at any time.1

Dose escalate to achieve or regain a response1

Callout DotsCallout Dots

80% of all COMMANDS patients receiving REBLOZYL
had their dose increased at least once2

Callout DotsCallout Dots
Dose titrations for esa-naïve patients on Reblozyl for MDSDose titrations for esa-naïve patients on Reblozyl for MDS

NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.

Do not increase dose more frequently than every 6 weeks (2 doses); do not increase dose beyond maximum dose.1

In the absence of transfusion, if predose Hgb is ≥11.5 g/dL or if Hgb increases >2 g/dL within 3 weeks, interrupt or decrease dose. See instructions for dosing modifications.1

For patients with IPSS-R very low-, low-, or intermediate-risk MDS non-del(5q) ± other cytogenetic abnormalities and RS <15% (or RS <5% with an SF3B1 mutation) with sEPO ≤500 mU/mL.3

Some patients in COMMANDS required a treatment interruption or dose reduction

For super-responders with predose hemoglobin ≥11.5 g/dL or rapid hemoglobin rise1:

SCENARIO REBLOZYL
Dosing recommendation
Predose Hgb is ≥11.5 g/dL in the absence of transfusions
  • Interrupt treatment
  • Restart when the Hgb is no more than 11 g/dL
Increase in Hgb >2 g/dL within 3 weeks in the absence of transfusions and:
Current dose is 1.75 mg/kg
  • Reduce dose to 1.33 mg/kg
Current dose is 1.33 mg/kg
  • Reduce dose to 1 mg/kg
Current dose is
1 mg/kg
  • Reduce dose to 0.8 mg/kg
Current dose is
0.8 mg/kg
  • Reduce dose to 0.6 mg/kg
Current dose is
0.6 mg/kg
  • Discontinue treatment

For adverse reactions1:

SCENARIO REBLOZYL
Dosing recommendation
Grade 3 or 4 hypersensitivity reactions#
  • Discontinue treatment
Other Grade 3 or 4 adverse reactions#
  • Interrupt treatment
  • When the adverse reaction resolves to no more than Grade 1, restart treatment at the next lower dose level||
  • If the dose delay is >12 consecutive weeks, discontinue treatment

Grade 1 is mild, Grade 2 is moderate, Grade 3 is severe, and Grade 4 is life threatening.

Per dose reductions in table above.

Dose modifications when administering REBLOZYL1

Dosing icon

Dose increases in the event of loss of response1

  • If, upon dose reduction, the patient loses response (ie, requires a transfusion) or Hgb concentration drops by 1 g/dL or more in 3 weeks in the absence of transfusion, increase the dose by 1 dose level
  • Wait a minimum of 6 weeks between dose increases
  • Dose increases to 1.33 mg/kg and subsequently to 1.75 mg/kg may occur at any time during treatment after patients have received at least 2 consecutive doses at the prior lower dose level
  • Do not increase the dose more frequently than every 2 consecutive doses (6 weeks) or beyond the maximum dose of 1.75 mg/kg
Stop icon

Discontinue treatment if no clinical benefit is observed1

  • Discontinue REBLOZYL if no increase in Hgb or reduction in RBC transfusion burden from baseline after at least 3 consecutive doses (9 weeks) at 1.75 mg/kg or if unacceptable toxicity occurs at any time

If a planned administration of REBLOZYL is delayed or missed1

  • Administer REBLOZYL as soon as possible and continue dosing as prescribed, with at least 3 weeks between doses

ESA=erythropoiesis-stimulating agent; Hgb=hemoglobin; MDS=myelodysplastic syndromes; RBC=red blood cell; RBCT=red blood cell transfusion; RBC-TI=red blood cell transfusion independence.

INDICATIONS

REBLOZYL® (luspatercept-aamt) is indicated for the treatment of anemia in adult patients with beta thalassemia who require regular red blood cell (RBC) transfusions.

REBLOZYL® (luspatercept-aamt) is indicated for the treatment of anemia without previous erythropoiesis stimulating agent use (ESA-naïve) in adult patients with very low- to intermediate-risk myelodysplastic syndromes (MDS) who may require regular red blood cell (RBC) transfusions.

REBLOZYL® (luspatercept-aamt) is indicated for the treatment of anemia failing an erythropoiesis stimulating agent and requiring 2 or more red blood cell (RBC) units over 8 weeks in adult patients with very low- to intermediate-risk myelodysplastic syndromes with ring sideroblasts (MDS-RS) or with myelodysplastic/myeloproliferative neoplasm with ring sideroblasts and thrombocytosis (MDS/MPN-RS-T).

REBLOZYL is not indicated for use as a substitute for RBC transfusions in patients who require immediate correction of anemia.

IMPORTANT SAFETY INFORMATION

WARNINGS AND PRECAUTIONS

Thrombosis/Thromboembolism

In adult patients with beta thalassemia, thromboembolic events (TEE) were reported in 8/223 (3.6%) of REBLOZYL-treated patients. TEEs included deep vein thrombosis, pulmonary embolus, portal vein thrombosis, and ischemic stroke. Patients with known risk factors for thromboembolism (splenectomy or concomitant use of hormone replacement therapy) may be at further increased risk of thromboembolic conditions. Consider thromboprophylaxis in patients at increased risk of TEE. Monitor patients for signs and symptoms of thromboembolic events and institute treatment promptly.

Hypertension

Hypertension was reported in 11.4% (63/554) of REBLOZYL-treated patients. Across clinical studies, the incidence of Grade 3 to 4 hypertension ranged from 2% to 9.6%. In patients with beta thalassemia with normal baseline blood pressure, 13 (6.2%) patients developed systolic blood pressure (SBP) ≥130 mm Hg and 33 (16.6%) patients developed diastolic blood pressure (DBP) ≥80 mm Hg. In ESA-refractory or -intolerant adult patients with MDS with normal baseline blood pressure, 26 (30%) patients developed SBP ≥130 mm Hg and 23 (16%) patients developed DBP ≥80 mm Hg. In ESA-naïve adult patients with MDS with normal baseline blood pressure, 23 (36%) patients developed SBP ≥140 mm Hg and 11 (6%) patients developed DBP ≥80 mm Hg. Monitor blood pressure prior to each administration. Manage new or exacerbations of preexisting hypertension using anti-hypertensive agents.

Extramedullary Hematopoietic (EMH) Masses

In adult patients with transfusion-dependent beta thalassemia, EMH masses were observed in 3.2% of REBLOZYL-treated patients, with spinal cord compression symptoms due to EMH masses occurring in 1.9% of patients (BELIEVE and REBLOZYL long-term follow-up study).

In a study of adult patients with non-transfusion-dependent beta thalassemia, a higher incidence of EMH masses was observed in 6.3% of REBLOZYL-treated patients vs. 2% of placebo-treated patients in the double-blind phase of the study, with spinal cord compression due to EMH masses occurring in 1 patient with a prior history of EMH. REBLOZYL is not indicated for use in patients with non-transfusion-dependent beta thalassemia.

Possible risk factors for the development of EMH masses in patients with beta thalassemia include history of EMH masses, splenectomy, splenomegaly, hepatomegaly, or low baseline hemoglobin (<8.5 g/dL). Signs and symptoms may vary depending on the anatomical location. Monitor patients with beta thalassemia at initiation and during treatment for symptoms and signs or complications resulting from the EMH masses and treat according to clinical guidelines. Discontinue treatment with REBLOZYL in case of serious complications due to EMH masses. Avoid use of REBLOZYL in patients requiring treatment to control the growth of EMH masses.

Embryo-Fetal Toxicity

REBLOZYL may cause fetal harm when administered to a pregnant woman. REBLOZYL caused increased post-implantation loss, decreased litter size, and an increased incidence of skeletal variations in pregnant rat and rabbit studies. Advise pregnant women of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment and for at least 3 months after the final dose.

ADVERSE REACTIONS

Beta-Thalassemia

Serious adverse reactions occurred in 3.6% of patients on REBLOZYL. Serious adverse reactions occurring in 1% of patients included cerebrovascular accident and deep vein thrombosis. A fatal adverse reaction occurred in 1 patient treated with REBLOZYL who died due to an unconfirmed case of acute myeloid leukemia (AML).

Most common adverse reactions (at least 10% for REBLOZYL and 1% more than placebo) were headache (26% vs 24%), bone pain (20% vs 8%), arthralgia (19% vs 12%), fatigue (14% vs 13%), cough (14% vs 11%), abdominal pain (14% vs 12%), diarrhea (12% vs 10%) and dizziness (11% vs 5%).

ESA-naïve adult patients with Myelodysplastic Syndromes

Grade ≥3 (≥2%) adverse reactions included hypertension and dyspnea.

The most common (≥10%) all-grade adverse reactions included diarrhea, fatigue, hypertension, peripheral edema, nausea, and dyspnea.

ESA-refractory or -intolerant adult patients with Myelodysplastic Syndromes

Grade ≥3 (≥2%) adverse reactions included fatigue, hypertension, syncope and musculoskeletal pain. A fatal adverse reaction occurred in 5 (2.1%) patients.

The most common (≥10%) adverse reactions included fatigue, musculoskeletal pain, dizziness, diarrhea, nausea, hypersensitivity reactions, hypertension, headache, upper respiratory tract infection, bronchitis, and urinary tract infection.

LACTATION

It is not known whether REBLOZYL is excreted into human milk or absorbed systemically after ingestion by a nursing infant. REBLOZYL was detected in milk of lactating rats. When a drug is present in animal milk, it is likely that the drug will be present in human milk. Because many drugs are excreted in human milk, and because of the unknown effects of REBLOZYL in infants, a decision should be made whether to discontinue nursing or to discontinue treatment. Because of the potential for serious adverse reactions in the breastfed child, breastfeeding is not recommended during treatment and for 3 months after the last dose.

DRUG ABUSE POTENTIAL

Abuse: Abuse of REBLOZYL may be seen in athletes for the effects on erythropoiesis. Misuse of drugs that increase erythropoiesis, such as REBLOZYL, by healthy persons may lead to polycythemia, which may be associated with life-threatening cardiovascular complications.

Please click here for US Full Prescribing Information for REBLOZYL.

References: 1. REBLOZYL [US Prescribing Information]. Summit, NJ: Celgene Corporation; 2024. 2. Santini V, Zeidan AM, Platzbecker U,et al. Clinical benefit of luspatercept treatment in transfusion-dependent, erythropoiesis-stimulating agent-naive patients with Very low-, Low- or Intermediate-risk myelodysplastic syndromes in the COMMANDS trial. Poster presented at: European Hematology Association (EHA) Hybrid Congress. June 13-16, 2024. Madrid, Spain. 3. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Myelodysplastic Syndromes V.3.2024. © National Comprehensive Cancer Network, Inc. 2024. All rights reserved. Accessed August 15, 2024. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.

GLOBAL Bristol Myers SquibbTM logo
GLOBAL Bristol Myers SquibbTM logo

REBLOZYL® is a trademark of Celgene Corporation, a Bristol Myers Squibb company.
Access Support® is a trademark of Bristol-Myers Squibb Company.
REBLOZYL® is licensed from Merck & Co., Inc., Rahway, NJ, USA and its affiliates.

© 2024 Bristol-Myers Squibb Company.
2007-US-2400257 10/2024

References: 1. REBLOZYL [US Prescribing Information]. Summit, NJ: Celgene Corporation; 2024. 2. Santini V, Zeidan AM, Platzbecker U,et al. Clinical benefit of luspatercept treatment in transfusion-dependent, erythropoiesis-stimulating agent-naive patients with Very low-, Low- or Intermediate-risk myelodysplastic syndromes in the COMMANDS trial. Poster presented at: European Hematology Association (EHA) Hybrid Congress. June 13-16, 2024. Madrid, Spain. 3. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Myelodysplastic Syndromes V.3.2024. © National Comprehensive Cancer Network, Inc. 2024. All rights reserved. Accessed August 15, 2024. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.