Severe Romiplostim-Induced Rebound Thrombocytopenia After Splenectomy for Refractory ITP

Choe, Michael J.; Packer, Clifford D.

doi:10.1177/1060028014555540

Cited by 8 publications

(6 citation statements)

References 15 publications

(15 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Uwagawa et al describe a case using eltrombopag to augment platelet counts prior to splenectomy [16]. Another case report describes recurrent thrombocytopenia after splenectomy after romiplostim dose was held in preparation for surgery; however, platelet count recovered once romiplostim was restarted [17]. As such, there may be a role for TPO-RAs in certain circumstances before splenectomy to increase platelet count to a safe surgical threshold.…”

Section: Discussionmentioning

confidence: 99%

Balancing Therapy with Thrombopoietin Receptor Agonists and Splenectomy in Refractory Immune Thrombocytopenic Purpura: A Case of Postsplenectomy Thrombocytosis Requiring Plateletpheresis

Zimmerman

Norsworthy

2016

Case Reports in Hematology

View full text Add to dashboard Cite

Immune thrombocytopenic purpura (ITP) causes thrombocytopenia through the autoimmune destruction of platelets. Corticosteroids remain the first line of therapy, and traditionally splenectomy has been the second. While the availability of thrombopoietin receptor agonists (TPO-RAs) has expanded treatment options, there is little data for the ideal management of these agents in preparation for splenectomy. Thrombocytosis has been reported after splenectomy in patients treated with TPO-RA preoperatively, with one prior case requiring plateletpheresis for symptomatic thrombocytosis. We present a case report and review of the literature pertaining to this complication and provide recommendations for preventing postsplenectomy thrombocytosis in ITP patients on TPO-RAs.

show abstract

Section: Discussionmentioning

confidence: 99%

Balancing Therapy with Thrombopoietin Receptor Agonists and Splenectomy in Refractory Immune Thrombocytopenic Purpura: A Case of Postsplenectomy Thrombocytosis Requiring Plateletpheresis

Zimmerman

Norsworthy

2016

Case Reports in Hematology

View full text Add to dashboard Cite

show abstract

“…12 Two patients required rescue therapy and platelet counts returned to baseline within three to seven days. Choe et al 10 reported a case of severe rebound thrombocytopenia after temporary discontinuation of romiplostim. The patient's platelet count of 434,000/mL necessitated that romiplostim dose be held according to prescribing information.…”

Section: Discussionmentioning

confidence: 99%

“…Choe et al. 10 reported a case of severe rebound thrombocytopenia after temporary discontinuation of romiplostim. The patient’s platelet count of 434,000/µL necessitated that romiplostim dose be held according to prescribing information.…”

Section: Discussionmentioning

confidence: 99%

“…6,9 Widely variable responses to romiplostim deviating from expected pharmacodynamic predictions have been reported. 10,11 In the original phase I/II trial, patients were randomized to receive either escalating doses of romiplostim (0.2 to 10 µg/kg/week) or six fixed doses of either 1, 3, or 6 µg/kg. 12 This study demonstrated that two of eight patients who received 3 µg/kg developed platelet counts in excess of 450,000/µL, which subsequently dropped to below 30,000/µL when drug was withheld.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Dynamic dosing of romiplostim in patients with immune thrombocytopenia purpura: Two case reports

Gilreath

Wei

Stolzmann

et al. 2018

J Oncol Pharm Pract

View full text Add to dashboard Cite

Romiplostim is a thrombopoietin receptor agonist approved for the treatment of immune thrombocytopenia purpura. When following FDA-approved romiplostim prescribing recommendations to withhold treatment for platelet counts above 400k/µL, some patients exhibit a precipitous decline in their platelet count potentially causing patient harm. We present two cases where stable platelet counts were achieved only through persistent weekly dosing of romiplostim despite platelet counts above 400k/µL on the day of administration. Therefore, continuous weekly dosing of romiplostim despite platelet count being above 400k/µL combined with twice weekly vigilant monitoring is an alternative method of romiplostim dosing that mitigates severe fluctuations in platelets. We also discuss important details, postulated mechanisms, and evidence-based mitigation strategies.

show abstract

“…Some studies suggest that romiplostim may be discontinued in select patients, even though there are concerns of a profound rebound thrombocytopenia following its discontinuation. 33 – 35 This is not a trivial question. Current wholesale price of romiplostim is $1,062.50 for a single-use vial of 250 µg or $2,125.00 for a single-use vial of 500 µg.…”

Section: Discussionmentioning

confidence: 99%

Long-term safety and efficacy of romiplostim for treatment of immune thrombocytopenia

Vishnu¹,

Aboulafia²

2016

JBM

View full text Add to dashboard Cite

Inhibition of platelet production and mediated by antiplatelet antibodies is a well-known mechanism causing low platelet counts in immune thrombocytopenia (ITP). Use of thrombopoietin receptor agonists increases platelet counts and decreases the risk of bleeding in patients with ITP. Two such thrombopoietin receptor agonists, romiplostim and eltrombopag, are approved by the US Food and Drug Administration to treat thrombocytopenia in adults, and most recently, children with persistent or chronic ITP. This review focuses on the efficacy data and safety analysis of the pooled data from the clinical trials evaluating romiplostim for treatment of adults with ITP. The rates of hemorrhage, thrombosis, hematologic and nonhematologic cancers, and myelodysplastic syndrome were not overrepresented among the groups who received romiplostim versus placebo or other standard-of-care treatments. Yet, as after-market experience with thrombopoietin receptor agonists increases, there are emerging reports of increased incidence of thrombosis and bone marrow reticulin among patients who are treated with long-term use of these agents. Ongoing clinical research will continue to evaluate romiplostim’s efficacy and safety in other primary and secondary thrombocytopenic states.

show abstract

Severe Romiplostim-Induced Rebound Thrombocytopenia After Splenectomy for Refractory ITP

Abstract: Physicians using romiplostim as a bridge to splenectomy should be cautious about withholding a scheduled dose around the time of surgery.

Cited by 8 publications

References 15 publications

Balancing Therapy with Thrombopoietin Receptor Agonists and Splenectomy in Refractory Immune Thrombocytopenic Purpura: A Case of Postsplenectomy Thrombocytosis Requiring Plateletpheresis

Balancing Therapy with Thrombopoietin Receptor Agonists and Splenectomy in Refractory Immune Thrombocytopenic Purpura: A Case of Postsplenectomy Thrombocytosis Requiring Plateletpheresis

Dynamic dosing of romiplostim in patients with immune thrombocytopenia purpura: Two case reports

Long-term safety and efficacy of romiplostim for treatment of immune thrombocytopenia

Contact Info

Product

Resources

About