Therefore, the HI-E responses observed in the current trial and the PACE-MDS trial [22, 29], together with a higher IWG-defined HI-E response rate observed with luspatercept compared with epoetin-α in ESA-naïve, TD patients in the COMMANDS trial (74% vs 51%; P < 0.0001) [21], suggests that treating LR-MDS patients with luspatercept earlier in the disease course prior to ESA therapy or RBC transfusions might be beneficial. The gene discussed is EPO; the disease is myelodysplastic syndrome.