Inclusion Criteria:
* Included in the Flatiron Health Broad Research Network, with 2 or more visits after January 1, 2011
* Has evidence of diagnosis with myelodysplastic syndromes (MDS) after Jan 1, 2020, as identified by a natural language processing (NLP)-based machine-learning (ML) model
* Has evidence of diagnosis with MDS as identified via structured International Classification of Diseases (ICD) codes:
* International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM): D46.x
* International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM): 238.7x
* Age ≥ 18 years at MDS diagnosis
* Has either ring sideroblasts positive or negative status, as confirmed by bone marrow aspirate lab results or clinician notes
* Has at least one confirmed structured activity more than 8 weeks prior to the index date
Cohort specific inclusion criteria:
First-line (1L) luspatercept cohort
* Has evidence of receipt of luspatercept as identified via structured data as evidenced by non-cancelled Medication Order or Medication Administration and confirmed via unstructured data
* Has evidence of treatment with luspatercept for at least 12 weeks as evidenced by non-cancelled Medication Orders or Medication Administrations
1L erythropoiesis stimulating agents (ESA) cohort:
* Has evidence of receipt of any ESA (i.e., epoetin alfa, darbepoetin alfa, epoetin beta, epoetin alfa-epbx, epoetin zeta, or epoetin beta-methoxy polyethylene glycol) for at least 12 weeks as evidenced by non-cancelled Medication Orders or Medication Administrations
* Note: this criterion is included to maximize alignment between the 1L ESA cohort and the 1L luspatercept cohort and minimize bias induced by the dosage requirement in the 1L luspatercept cohort
Second-lin (2L) luspatercept cohort:
* Has evidence of receipt of luspatercept as identified via structured data as evidenced by non-cancelled Medication Order or Medication Administration and confirmed via unstructured data
* Has evidence of receipt of at least 1 ESA as evidenced by a non-cancelled medication order or medication administration prior to the date of initial luspatercept receipt
* Has evidence of treatment with luspatercept for at least 12 weeks as evidenced by non-cancelled Medication Orders or Medication Administrations
Exclusion Criteria:
* Lacking relevant unstructured documents in the Flatiron database for review by the abstraction team
* Have been exposed to any of the following MDS-related therapy prior to luspatercept initiation in the 1L and 2L settings or ESA initiation in the 1L setting: lenalidomide, azacitidine, decitabine, cedazuridine, eltrombopag, cytarabine, daunorubicin, idarubicin, filgrastim, pegfilgrastim, lipefilgrastim, sargramostim, venetoclax, or has evidence of a stem cell transplant
