In low-risk MDS patients with symptomatic anemia and a low EPO level, how does the presence of a high-frequency SF3B1 mutation influence your first-line choice between an ESA and luspatercept?

I would consider the SF3B1 mutation to be the relevant biomarker for the selection of frontline therapy (namely luspatercept) in this case. The correlation between SF3B1 mutations and the presence of ring sideroblasts in MDS is strong but not perfect. This could be for a variety of reasons, the most...