LR-MDS AND REBLOZYL: ESA LIMITATIONS AND THE NEED FOR REBLOZYL

Most patients don’t respond to ESAs1

For your newly diagnosed patients with LR-MDS–associated anemia

Will ESAs meet your treatment goals?

SOHO 2024: A retrospective real-world analysis of patients with 1L LR-MDS treated from 2018-2023 at Florida Cancer Specialists & Research Institute (FCS)1

~7 out of 10 patients without an alternate 1L option failed to respond to ESAs. Refer to reference 1 and the asterisk and dagger footnotes for more details.

Based on NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), no response
to ESAs is defined as

<1.5 g/dL

rise in Hgb

OR

no decrease

in RBCT requirement

by 6-8 weeks of treatment2

gradient rule

359 total patients1,3

RS- (<5%)

59%

(n=213)

EPO <200 U/L

59%

(n=211)

Median sEPO

47.5 U/L

(n=243)

gradient rule
Callout Dots

It’s time to start strong with a different option.

Callout Dots

Analysis limitations: Results should be interpreted with caution, as this was a retrospective analysis from a single large cancer center and cohorts were not prospectively defined nor powered to detect significant differences.1

*Non-interventional, retrospective review of clinical data from electronic medical records of patients treated at FCS with diagnoses of LR-MDS from 2018 to 2022, 1 year of follow-up data from initial diagnosis, ≥6 months of data prior to diagnosis, LR-MDS at diagnosis defined as IPSS score of low or intermediate-1 or IPSS-R score of very low, low, or intermediate, and age ≥18 years. Patients treated with luspatercept prior to an ESA or those participating in a clinical trial at any time during the study period were excluded. Treatment failure on ESAs was defined as the number and proportion of patients with <1.5 g/dL rise in Hgb by 6-8 weeks of treatment or no decrease in RBCT requirement by 6-8 weeks of treatment.1

†68% of patients experienced ESA failure.1

1L=first-line; EPO=erythropoietin; ESA=erythropoiesis-stimulating agent; Hgb=hemoglobin; IPSS=International Prognostic Scoring System; IPSS-R=Revised International Prognostic Scoring System; LR-MDS=lower-risk myelodysplastic syndromes; MDS=myelodysplastic syndromes; NCCN=National Comprehensive Cancer Network; RBCT=red blood cell transfusion; RS=ring sideroblast; sEPO=serum erythropoietin; SOHO=Society of Hematologic Oncology.

Raise the standard of care with REBLOZYL

Explore efficacy data

References: 1. Fonseca G, Warner A, Ming A, et al. Management of patients with lower-risk myelodysplastic syndromes in a large US community oncology practice: a focus on patient outcomes post erythropoiesis-stimulating agent treatment. Presented at: Society of Hematologic Oncology (SOHO) Annual Meeting. September 4-7, 2024. Houston, TX, USA. 2. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Myelodysplastic Syndromes V.1.2025. © National Comprehensive Cancer Network, Inc. 2024. All rights reserved. Accessed November 18, 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. 3. Data on file. BMS-REF-00715-2007. Princeton, NJ: Bristol-Myers Squibb Company; 2023.

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.

For more information, please see US Full Prescribing Information for REBLOZYL.

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REBLOZYL® is licensed from Merck & Co. Inc., Rahway, NJ, USA and its affiliates.

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2007-US-2400451   12/2024