A single center experience with romiplostim for the management of chemotherapy‐induced thrombocytopenia

Miao, Jennifer; Leblebjian, Houry; Scullion, Bridget; Parnes, Aric

doi:10.1002/ajh.25022

Cited by 14 publications

(16 citation statements)

References 6 publications

(6 reference statements)

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“…Darbepoetin alfa has been used for chemotherapy-induced anaemia in JW patients with leukaemias and solid tumours 11. Use of romiplostim in myelodysplastic syndrome as well as chemotherapy-induced thrombocytopaenia has also been described 12–15. Here, we report successful use of ESA and TPOR for management of cytopenias in a JW patient with ALL.…”

Section: Discussionmentioning

confidence: 82%

Use of platelet and erythroid growth factors during induction chemotherapy for acute lymphoblastic leukaemia in a Jehovah’s Witness

Arora

Gupta

et al. 2018

BMJ Case Rep

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We present a 21-year-old woman diagnosed with Philadelphia (Ph) chromosome-like CD20 positive B-cell acute lymphoblastic leukaemia (ALL). She was a Jehovah’s Witness (JW) and declined all blood product transfusion support. She was initiated on the CALGB 10403 chemotherapy protocol for her ALL. She received darbepoetin alfa and romiplostim as supportive therapies for her disease/chemotherapy-associated anaemia and thrombocytopaenia. A complete remission was achieved with negative minimal residual disease and she remains in remission 18 months after diagnosis. This case report describes the successful treatment of an adult JW with Ph-like CD20 +B cell ALL, in the absence of blood product transfusions, using growth factor support.

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Section: Discussionmentioning

confidence: 82%

Use of platelet and erythroid growth factors during induction chemotherapy for acute lymphoblastic leukaemia in a Jehovah’s Witness

Arora

Gupta

et al. 2018

BMJ Case Rep

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“…To date, studies of romiplostim to manage CIT have been limited to case series and small single-center studies. [18][19][20][21] These studies suggest that romiplostim is effective in raising the platelet count in patients with solid tumors. Predictors of romiplostim non-response, optimal dosing regimens, and use in non-myeloid hematologic malignancies (lymphoma and myeloma) have not been evaluated.…”

Section: Introductionmentioning

confidence: 92%

“…Four single-center studies, each evaluating between 20-52 solid tumor patients receiving romiplostim for CIT, [18][19][20][21] concluded that romiplostim is effective in raising the platelet count in CIT but did not compare different dosing strategies or characterize predictors of romiplostim nonresponse. None of these studies evaluated bleeding, the primary hazard of thrombocytopenia, and only limited data on the impact of romiplostim treatment on chemotherapy dose reductions and treatment delays were described.…”

mentioning

confidence: 99%

A multicenter study of romiplostim for chemotherapy-induced thrombocytopenia in solid tumors and hematologic malignancies

et al. 2020

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Chemotherapy-induced thrombocytopenia (CIT) frequently complicates cancer treatment causing chemotherapy delays, dose reductions, and discontinuation. There is no FDA-approved agent available to manage CIT. This study retrospectively evaluated patients with CIT treated on institutional romiplostim treatment pathways at 4 U.S. centers. The primary outcome was achievement of a romiplostim response [median on-romiplostim platelet count (Plt) ≥75x109/L and ≥30x109/L above baseline]. Secondary outcomes included time to Plt≥100x109/L and rates of the following: Plt<100x109/L, Plt<75x109/L, Plt<50x109/L, thrombocytosis, chemotherapy dose reduction/treatment delay, platelet transfusion, bleeding, and thromboembolism. Multivariable regression was used to identify predictors of romiplostim non-response and compare weekly dosing with intracycle/intermittent dosing. 173 patients (153 solid tumor, 20 lymphoma or myeloma) were treated, with 170 (98%) receiving a median of 4 (range, 1-36) additional chemotherapy cycles on romiplostim. Romiplostim was effective in solid tumor patients: 71% of patients achieved a romiplostim response, 79% avoided chemotherapy dose reductions/treatment delays and 89% avoided platelet transfusions. Median per-patient Plt on romiplostim was significantly higher than baseline (116x109/L vs. 60x109/L, P<0.001). Bone marrow tumor invasion, prior pelvic irradiation, and prior temozolomide predicted romiplostim non-response. Bleeding rates were lower than historical CIT cohorts and thrombosis rates were not elevated. Weekly dosing was superior to intracycle dosing with higher response rates and less chemotherapy dose reductions/treatment delays (IRR 3.00, 95% CI 1.30-6.91, P=0.010) or bleeding (IRR 4.84, 95% CI 1.18-19.89, P=0.029). Blunted response (10% response rate) was seen in non-myeloid hematologic malignancy patients with bone marrow involvement. In conclusion, romiplostim was safe and effective for CIT in most solid tumor patients.

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“…Until recently, studies investigating romiplostim for the management of CIT have been limited to case series and small singlecenter studies. [7][8][9] A case series of 20 patients with solid tumors and CIT reported that romiplostim treatment improved platelet counts in all patients, allowing for resumption of chemotherapy. 9 In a retrospective study of 37 patients with solid tumors and CIT, treatment with The NCCN Guidelines ® and this illustration may not be reproduced in any form without the express written permission of NCCN.…”

Section: Romiplostimmentioning

confidence: 99%

NCCN Guidelines® Insights: Hematopoietic Growth Factors, Version 1.2022

Griffiths¹,

Roy²,

Alwan

et al. 2022

Journal of the National Comprehensive Cancer Network

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The NCCN Guidelines for Hematopoietic Growth Factors provide recommendations for the appropriate use of growth factors in the clinical management of febrile neutropenia (FN), chemotherapy-induced thrombocytopenia (CIT), and chemotherapy-induced anemia (CIA). Management and prevention of these sequelae are an integral part of supportive care for many patients undergoing cancer treatment. The purpose of these guidelines is to operationalize the evaluation, prevention, and treatment of FN, CIT, and CIA in adult patients with nonmyeloid malignancies and to enable the patient and clinician to assess management options for FN, CIT, and CIA in the context of an individual patient’s condition. These NCCN Guidelines Insights provide a summary of the important recent updates to the NCCN Guidelines for Hematopoietic Growth Factors, with particular emphasis on the incorporation of a newly developed section on CIT.

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A single center experience with romiplostim for the management of chemotherapy‐induced thrombocytopenia

Cited by 14 publications

References 6 publications

Use of platelet and erythroid growth factors during induction chemotherapy for acute lymphoblastic leukaemia in a Jehovah’s Witness

Use of platelet and erythroid growth factors during induction chemotherapy for acute lymphoblastic leukaemia in a Jehovah’s Witness

A multicenter study of romiplostim for chemotherapy-induced thrombocytopenia in solid tumors and hematologic malignancies

NCCN Guidelines® Insights: Hematopoietic Growth Factors, Version 1.2022

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