Following a Frontline Forum discussion for CancerNetwork®, Amer Zeidan, MBBS, MD, professor of medicine at Yale School of Medicine and chief of the Division of Hematologic Malignancies, director of Hematology Early Therapeutics Research, and assistant director of the Clinical Trial Office for Hematology at Yale Comprehensive Cancer Center addressed whether the phase 3b MAXILUS study (NCT06045689) should change how he doses luspatercept-aamt (Reblozyl) in lower-risk myelodysplastic syndromes (MDS). MAXILUS evaluated initiating luspatercept at the maximum approved dose of 1.75 mg/kg rather than titrating up from the standard 1 mg/kg starting dose.
Zeidan explained that, although full-dose initiation appeared safe and effective, he still individualizes the decision, reserving full upfront dosing for patients he expects to respond poorly to the starting dose, such as those with a heavy transfusion burden or ring sideroblast (RS)–negative disease with higher erythropoietin (EPO) levels.
Transcript:
CancerNetwork: Based on the MAXILUS trial, are you now bypassing conventional luspatercept titration in clinical practice and going straight to the maximum 1.75 mg/kg dose to achieve faster hemoglobin normalization?
Zeidan: The MAXILUS trial established that starting most patients on the full dose of luspatercept from the outset is safe and leads to comparable efficacy, and probably better efficacy, for some patients in terms of reaching a full response sooner. However, I would still use the standard dosing approach for some patients and the MAXILUS approach for others, depending on the situation. For patients I expect to have a low chance of responding to the starting dose of 1 mg/kg, for example those with a heavy transfusion burden or those who are RS negative with higher EPO levels, I might start with the full dose from the outset. I still use an individualized approach in deciding on the dose.
Reference
Della Porta MG, Diez-Campelo M, Santini V, et al. Luspatercept initiated at the maximum-approved dose in patients with lower-risk myelodysplastic syndromes who require transfusions: primary analysis from MAXILUS. Presented at: 2026 European Hematology Association Congress; June 11-14, 2026; Stockholm, Sweden. Abstract S173.
