Risk and consequences of chemotherapy-induced thrombocytopenia in US clinical practice

Abstract

Background Chemotherapy-induced thrombocytopenia (CIT) is a potentially serious complication that can lead to chemotherapy dose delays, dose reductions, or discontinuation, and increases the risk of serious bleeding events. The objectives of this study were to characterize the incidence, clinical consequences, and economic costs of CIT in current US clinical practice. Methods A retrospective cohort design and data from two US private healthcare claims repositories (01/2010–12/2016) were employed. Study population comprised adults who received selected myelosuppressive chemotherapy regimens for solid tumors or non-Hodgkin’s lymphoma. CIT was identified based on: diagnosis code for thrombocytopenia or bleeding; procedure code for platelet transfusion or bleeding control; or drug code for thrombopoietin-receptor agonist. Incidence of CIT was evaluated during the chemotherapy course (max. no. cycles = 8), and associated consequences and costs (2016US$) were evaluated during the cycle of the CIT episode. Results Among 215,508 cancer chemotherapy patients, CIT incidence during the course (mean no. cycles = 4.6) was 9.7% (95% CI: 9.6–9.8), and ranged from 6.1% (5.9–6.3) for regimens containing cyclophosphamide to 13.5% (12.7–14.3) for regimens containing gemcitabine; among all patients, incidence was 2.7% (2.6–2.8) in cycle 1, 2.7% (2.6–2.8) in cycle 2, and 2.9% (2.9–3.0) in cycles thereafter. One-third of CIT episodes were managed in hospital, and for the subset of patients hospitalized with a first-listed diagnosis of CIT, mean length of stay was 4.6 (4.4–5.0) days and mean cost of inpatient care was $36,448 (32,332-41,331). Across cycles with CIT, mean cost of CIT-related care was $2179 (2029-2329), comprising $1024 (881–1167) for inpatient care and $1153 (1119-1187) for outpatient care. Conclusions In this retrospective evaluation of cancer chemotherapy patients, CIT incidence was high, especially among patients receiving gemcitabine-based regimens, and the costs of CIT-related care were substantial. Accordingly, interventions aimed at identifying and targeting high-risk patients for preventative measures may yield substantial clinical and economic benefits. Electronic supplementary material The online version of this article (10.1186/s12885-019-5354-5) contains supplementary material, which is available to authorized users.

Drug-Induced Thrombocytopenia: Mechanisms and Laboratory Diagnostics

“…10 In a recently published retrospective study based on data obtained from two U.S. private health care claims repositories (temporal range: January 2010 to December 2016), the incidence of CIT among 215,508 patients receiving chemotherapy was 9.7% (95% confidence interval [CI]: 9.6-9.8), ranging from 6.1% (95% CI: 5.9-6.3%) for treatments containing cyclophosphamide to 13.5% (95% CI: 12.7-14.3%) for those containing gemcitabine. 9 The frequency of CIT has, however, partially declined over the years. In a retrospective analysis performed in 1984 including 501 patients affected by gynecologic cancer treated with chemotherapy, CIT had developed in 36.3% of patients, 11 whereas a study conducted 15 years later reported that CIT occurred in 14.8% of patients.…”

The incidence of thrombocytopenia in adult patients receiving chemotherapy for solid tumors or hematologic malignancies

“…Thrombocytopenia, an abnormally low blood platelet count, is a common side effect of myelosuppressive chemotherapy 1‐3 . Prior studies estimated that approximately 10% to 38% of patients with a solid tumor and 40% to 68% of patients with a hematologic malignancy experience thrombocytopenia 3‐7 . The incidence and prevalence of chemotherapy‐induced thrombocytopenia (CIT) vary greatly by type of cancer and chemotherapy regimen, for example, from 16% in head and neck cancer to 68% in hematologic cancers, and from 8% in taxane‐based regimens to 37% in gemcitabine‐based regimens and 82% in carboplatin monotherapy 2,3,7,8 .…”

“…Prior studies estimated that approximately 10% to 38% of patients with a solid tumor and 40% to 68% of patients with a hematologic malignancy experience thrombocytopenia 3‐7 . The incidence and prevalence of chemotherapy‐induced thrombocytopenia (CIT) vary greatly by type of cancer and chemotherapy regimen, for example, from 16% in head and neck cancer to 68% in hematologic cancers, and from 8% in taxane‐based regimens to 37% in gemcitabine‐based regimens and 82% in carboplatin monotherapy 2,3,7,8 . Gemcitabine‐based and platinum‐based regimens have consistently been associated with the highest risk of thrombocytopenia 1‐3 .…”

Clinical Candidates Targeting the ATR–CHK1–WEE1 Axis in Cancer

“…Combinatorial regimens of ATRi with chemotherapy could also benefit from combination with subtherapeutic doses of DNA-damaging agents. Chemotherapeutics such as antimetabolites, crosslinking agents, or topoisomerase inhibitors (e.g., gemcitabine, cisplatin, or topotecan, respectively) can also cause myelosuppression by themselves [ 161 , 162 , 163 ]; thus, dose reduction might prevent their potential toxic events.…”