Response of complex immune‐mediated thrombocytopenia to romiplostim in the setting of allogeneic stem cell transplantation for chronic myelogenous leukemia

Bollag, Roni J.; Sterett, Meghan; Reding, Mark T.; Key, Nigel S.; Cohn, Claudia S.; Üstün, Celalettin

doi:10.1111/j.1600-0609.2012.01832.x

Cited by 16 publications

(13 citation statements)

References 14 publications

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“…Bruno et al reported that SFPR not due to recurrent malignancy was observed in 20% of patients undergoing allogeneic HCT and was associated with serious complications and poor outcomes [21]. Seven reports have described a total of 22 patients with SFPR who were treated with a TPO-R agonist after HCT (Table 4) [13][14][15][16][17][18][19]. All of these patients were treated with romiplostim and 20 (91%) achieved transfusion independence.…”

Section: Discussionmentioning

confidence: 99%

“…Their safety and efficacy have been reported for idiopathic thrombocytopenia purpura [8] and for thrombocytopenia in other conditions [9][10][11][12]. Several studies have reported the efficacy of romiplostim for the treatment of thrombocytopenia after allogeneic HCT [13][14][15][16][17][18][19], but data on eltrombopag treatment after allogeneic HCT are lacking. We report our experiences with 12 consecutive patients treated with eltrombopag for severe thrombocytopenia after allogeneic HCT at our center.…”

Section: Introductionmentioning

confidence: 99%

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Eltrombopag for Treatment of Thrombocytopenia after Allogeneic Hematopoietic Cell Transplantation

Tanaka¹,

Inamoto²,

Yamashita³

et al. 2016

Biology of Blood and Marrow Transplantation

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Persistent thrombocytopenia is a common complication after allogeneic hematopoietic cell transplantation (HCT). Eltrombopag is an oral thrombopoietin receptor agonist whose efficacy against persistent thrombocytopenia after allogeneic HCT has not been well characterized. This retrospective study evaluated the safety and efficacy of eltrombopag in 12 consecutive patients with persistent thrombocytopenia after allogeneic HCT. Eltrombopag was started at 12.5 mg once daily and the dose was increased by 12.5 mg daily every week until platelet counts exceeded 50,000/μL. Five patients had prolonged isolated thrombocytopenia (PIT) and 7 patients had secondary failure of platelet recovery (SFPR). The cumulative incidence rate of successful platelet recovery to ≥50,000/μL without transfusion support was 60% in PIT patients and 71% in SFPR patients. No patients discontinued the drug because of adverse events or intolerability. Notably, the rate of platelet recovery was higher (100% versus 58%; P = .0017) and recovery was faster (median, 33 days versus 137 days; P = .0078) in patients with normal numbers of bone marrow megakaryocytes before starting eltrombopag than in those with decreased numbers of megakaryocytes. Eltrombopag is a promising treatment for both PIT and SFPR after allogeneic HCT. The number of megakaryocytes in bone marrow before eltrombopag treatment may predict the response to eltrombopag.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Eltrombopag for Treatment of Thrombocytopenia after Allogeneic Hematopoietic Cell Transplantation

Tanaka¹,

Inamoto²,

Yamashita³

et al. 2016

Biology of Blood and Marrow Transplantation

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“…Twelve reports of 68 patients treated with romiplostim for prolonged thrombocytopenia following HCT were included in this review as shown in Table 2. [38][39][40][46][47][48][49][50][51][52][53][54] An additional 70 patients treated with romiplostim were reported in three articles that also included patients treated with eltrombopag as shown in Table 4. [55][56][57] Of the romiplostim treated patients, four reports included pediatric patients.…”

Section: Romiplostim For Delayed Thrombocytopenia Following Hctmentioning

confidence: 99%

“…Of the studies included in this review, several evaluated patients for development or progression of MF. 37,39,42,46,50,54,55,58,60 Only one patient in the included articles developed MF after starting treatment with TPO-RA. 39 This patient was treated with romiplostim for eight doses at a maximum dose of 8 µg/kg/wk.…”

Section: Bone Marrow Reticulin Formation and Collagen Fibrosismentioning

confidence: 99%

Use of thrombopoietin receptor agonists after hematopoietic progenitor cell transplantation

Singer

William

2020

Adv. Cell Gene Ther.

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Hematopoietic stem cell transplant (HCT) is used with increasing frequency for the treatment of malignant and nonmalignant diseases. Thrombocytopenia is a common complication following HCT and is associated with decreased survival. Supportive care with platelet transfusion requires significant resources, reduces quality of life, and is associated with several adverse effects including transfusion reaction, infection, and alloimmunization. Thrombopoeitin receptor agonists (TPO-RA) have been found to be safe and effective for the treatment of immune mediated thrombocytopenia, thrombocytopenia related to bone marrow failure syndromes, and thrombocytopenia of chronic liver disease. We hereby discuss in this review the evidence for use of TPO-RA for the management of thrombocytopenia after HCT.

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“…Vincristine and alemtuzumab have been used in isolated case reports [51,52]. The use of romiplostim in refractory thrombocytopenia after glucocorticoids, IVIG, and rituximab has been reported in several case reports [45,[53][54][55][56]. Eltrombopag has been attempted in 2 cases of refractory thrombocytopenia after allogeneic and autologous HSCT, with minimal success [57].…”

Section: Autoimmune Thrombocytopeniamentioning

confidence: 99%

Immune-Mediated Complications after Hematopoietic Stem Cell Transplantation

Rubinstein

Thota

et al. 2016

Biology of Blood and Marrow Transplantation

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Hematopoietic stem cell transplantation (HSCT) has an integral role in the treatment of malignant and nonmalignant diseases. Long-term complications after HSCT have been well established and include graft-versus-host disease (GVHD), conditioning regimen-related toxicities, disease relapse, and infections. Immune-mediated phenomena are increasingly described after HSCT with clinically significant sequelae. Diagnosis is challenging because of features that overlap with other commonly reported post-transplantation complications. Patients who experience immune-mediated disease after HSCT tend to have poor outcomes. Early recognition of immune-mediated complications is imperative to reduce preventable morbidity and mortality. This review looks at the currently available literature on pathogenesis, incidence, risk factors, treatment, and outcomes of immune-mediated disease (other than GVHD) after HSCT.

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Response of complex immune‐mediated thrombocytopenia to romiplostim in the setting of allogeneic stem cell transplantation for chronic myelogenous leukemia

Cited by 16 publications

References 14 publications

Eltrombopag for Treatment of Thrombocytopenia after Allogeneic Hematopoietic Cell Transplantation

Eltrombopag for Treatment of Thrombocytopenia after Allogeneic Hematopoietic Cell Transplantation

Use of thrombopoietin receptor agonists after hematopoietic progenitor cell transplantation

Immune-Mediated Complications after Hematopoietic Stem Cell Transplantation

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