A Case Series of SGLT2i Improving Hemoglobin in Adults with Myelodysplastic Syndrome

The objective of our case series was to assess the change in hemoglobin for adults with myelodysplastic syndrome (MDS) started on a sodium glucose cotransporter 2 inhibitor (SGLT2i) for their diabetes, heart failure, or chronic kidney disease.

Four patients with bone marrow biopsy confirmed low- or intermediate-risk MDS were referred for consideration of SGLT2i between July 2024 and December 2024. The patients were followed prospectively and had a repeat complete blood count at least 3 months after starting empagliflozin at 10 mg daily. The patients provided written consent for their results to be published. Median age was 78 years (range 76-82 years), 3 of the 4 patients were men, and the median baseline hemoglobin was 11.6 g/dL (IQR 9.3-12.8). Over a median duration of 4 months of taking empagliflozin, the median repeat hemoglobin was 12.8 g/dL (IQR 10.3-13.7).

In our case series of 4 patients with MDS started on empagliflozin, we observed an increase in hemoglobin for all 4 patients. Larger studies are needed to assess whether the increase in hemoglobin is sufficiently robust and sustained to reduce a person's need for future red blood cell transfusion or other treatments for MDS.