{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T02:01:15Z","timestamp":1771207275028,"version":"3.50.1"},"reference-count":32,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100002491","name":"Bristol-Myers Squibb","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002491","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["American J Hematol"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    The COMMANDS trial established luspatercept as a first\u2010line treatment for anemia in transfusion\u2010dependent lower\u2010risk (LR) myelodysplastic syndromes (MDS). Here we report red blood cell (RBC) transfusion response analysis based on somatic mutations profile and disease risk for patients treated with luspatercept or epoetin alfa in the COMMANDS trial. Of 350 evaluable patients, 238 (68.0%) had MDS with multiple lineage dysplasia and ring sideroblasts (RS) according to World Health Organization 2016 criteria, and 320 (91.4%) had somatic mutations in \u2265\u20091 gene (median, 2) with median variant allele frequencies (VAF) of 2%\u201359%. Mutation profiles were similar in the treatment groups. Luspatercept had superior responses versus epoetin alfa across multiple mutations (risk difference; RD, [95% confidence interval; CI] 0.25 [0.15\u20130.35]), including in\n                    <jats:italic>SF3B1<\/jats:italic>\n                    \u2010mutated (0.38 [0.25\u20130.50]) and\n                    <jats:italic>SF3B1<\/jats:italic>\n                    wild\u2010type (0.09 [\u22120.11 to 0.30]). Luspatercept demonstrated superior responses in patients with VAF \u2265\u200910% (random effect, 0.36 [95% CI, 0.28\u20130.44]), and in those with 1 (63% vs. 40%;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.040), 2 (70% vs. 27%;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), and 3 (72% vs. 40%;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.018) mutations, and across the low (75% vs. 38%), moderate low (61% vs. 38%), moderate high (44% vs. 21%), and high (36% vs. 24%) Molecular International Prognostic Scoring System risk groups (summary effect RD, 0.26 [95% CI, 0.14\u20130.37]). Across most mutations luspatercept responses were superior (random effect, 0.34 [95% CI, 0.24\u20130.44]) in patients with RS but were similar between treatments in RS\u2010negative patients. Luspatercept represents an effective treatment option in various mutational backgrounds in LR MDS.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Trial Registration:<\/jats:bold>\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">ClinicalTrials.gov<\/jats:ext-link>\n                    Identifier: NCT03682536.\n                  <\/jats:p>","DOI":"10.1002\/ajh.70171","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T08:57:24Z","timestamp":1768813044000},"page":"427-438","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Mutational Landscape and Burden on\n                    <scp>RBC<\/scp>\n                    Transfusion Response in Patients With Lower\u2010Risk Myelodysplastic Syndromes (\n                    <scp>LR<\/scp>\n                    \u2010\n                    <scp>MDS<\/scp>\n                    ) in the\n                    <scp>COMMANDS<\/scp>\n                    Study"],"prefix":"10.1002","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1876-5269","authenticated-orcid":false,"given":"Rami S.","family":"Komrokji","sequence":"first","affiliation":[{"name":"Moffitt Cancer Center  Tampa Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheida","family":"Hayati","sequence":"additional","affiliation":[{"name":"Global Biometrics and Data Sciences Bristol Myers Squibb  Princeton New Jersey USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuel","family":"Ugidos","sequence":"additional","affiliation":[{"name":"BMS Center for Innovation and Translational Research Europe (CITRE)  Seville Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3631-2482","authenticated-orcid":false,"given":"Guillermo","family":"Garcia\u2010Manero","sequence":"additional","affiliation":[{"name":"Department of Leukemia The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo Giovanni","family":"Della Porta","sequence":"additional","affiliation":[{"name":"Cancer Center IRCCS Humanitas Research Hospital  Milan Italy"},{"name":"Department of Biomedical Sciences Humanitas University  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amer M.","family":"Zeidan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Yale School of Medicine and Yale Cancer Center Yale University  New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5439-2172","authenticated-orcid":false,"given":"Valeria","family":"Santini","sequence":"additional","affiliation":[{"name":"MDS Unit, DMSC, Azienda Ospedaliero\u2010Universitaria Careggi University of Florence  Florence Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Uwe","family":"Platzbecker","sequence":"additional","affiliation":[{"name":"Medical Clinic and Policlinic 1, Hematology and Cellular Therapy University Hospital Leipzig  Leipzig Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anita K.","family":"Gandhi","sequence":"additional","affiliation":[{"name":"Hematology, Translational Medicine and Disease Team, Bristol Myers Squibb  Summit New Jersey USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2754-1782","authenticated-orcid":false,"given":"Rajasekhar N. 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