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

Shaw, J.; Nielson, Carrie M.; Park, Joseph K.; Marongiu, Andrea; Soff, Gerald A.

doi:10.1111/ejh.13595

Cited by 45 publications

(47 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a more recent analysis of 15,521 patients with solid tumors, 56 12.8% (95% CI: 12.3–13.4%) had CIT: grade 2 in 6.4%; grade 3 in 4.2% and grade 4 in 1.9%. CIT was more common in patients with solid tumors who received gemcitabine- and platinum-based regimens (14.8% and 13.5%, respectively) than in patients treated with anthracyclineor taxane-based regimens (9.3% and 6.5%, respectively).…”

Section: The Incidence Of Thrombocytopenia and The Use Of Platelet Tr...mentioning

confidence: 98%

Treatment of chemotherapy-induced thrombocytopenia in patients with non-hematologic malignancies

Kuter

2022

haematol

View full text Add to dashboard Cite

Chemotherapy-induced thrombocytopenia (CIT) is a common complication of the treatment of non-hematologic malignancies. Many patient-related variables (e.g., age, tumor type, number of prior chemotherapy cycles, amount of bone marrow tumor involvement) determine the extent of CIT. CIT is related to the type and dose of chemotherapy, with regimens containing gemcitabine, platinum, or temozolomide producing it most commonly. Bleeding and the need for platelet transfusions in CIT are rather uncommon except in patients with platelet counts below 25x109/L in whom bleeding rates increase significantly and platelet transfusions are the only treatment. Nonetheless, platelet counts below 70x109/L present a challenge. In patients with such counts, it is important to exclude other causes of thrombocytopenia (medications, infection, thrombotic microangiopathy, post-transfusion purpura, coagulopathy and immune thrombocytopenia). If these are not present, the common approach is to reduce chemotherapy dose intensity or switch to other agents. Unfortunately decreasing relative dose intensity is associated with reduced tumor response and remission rates. Thrombopoietic growth factors (recombinant human thrombopoietin, pegylated human megakaryocyte growth and development factor, romiplostim, eltrombopag, avatrombopag and hetrombopag) improve pretreatment and nadir platelet counts, reduce the need for platelet transfusions, and enable chemotherapy dose intensity to be maintained. National Comprehensive Cancer Network guidelines permit their use but their widespread adoption awaits adequate phase III randomized, placebo-controlled studies demonstrating maintenance of relative dose intensity, reduction of platelet transfusions and bleeding, and possibly improved survival. Their potential appropriate use also depends on consensus by the oncology community as to what constitutes an appropriate pretreatment platelet count as well as identification of patient-related and treatment variables that might predict bleeding.

show abstract

Section: The Incidence Of Thrombocytopenia and The Use Of Platelet Tr...mentioning

confidence: 98%

Treatment of chemotherapy-induced thrombocytopenia in patients with non-hematologic malignancies

Kuter

2022

haematol

View full text Add to dashboard Cite

show abstract

“… 5 A retrospective cohort study of 2537 patients with hematologic malignancies reported a 28% incidence of thrombocytopenia to <100 000/µL, with 16% of patients experiencing platelet counts <50 000/µL. 6 Certain chemotherapeutics used in the treatment of solid tumors such as gemcitabine and platinum-based agents are frequently associated with thrombocytopenia (30%-50% incidence), with platelet counts <50 000/µL occurring in 5% to 10% of patients. 7,8 The appropriate management of acute VTE and thrombocytopenia is uncertain.…”

Section: Introductionmentioning

confidence: 99%

Anticoagulation in cancer-associated thromboembolism with thrombocytopenia: a prospective, multicenter cohort study

et al. 2021

View full text Add to dashboard Cite

Venous thromboembolism (VTE) with concurrent thrombocytopenia is frequently encountered in patients with cancer. Therapeutic anticoagulation in the setting of thrombocytopenia is associated with a high risk of hemorrhage. Retrospective analyses suggest the utility of modified-dose anticoagulation in this population. To assess the incidence of hemorrhage or thrombosis according to anticoagulation strategy, we performed a prospective, multi-center, observational study. Patients with active malignancy, acute VTE, and concurrent thrombocytopenia (platelet count < 100,000/µL) were enrolled. The cumulative incidences of hemorrhage or recurrent VTE were determined considering death as a competing risk. Primary outcomes were centrally adjudicated and comparisons made according to initial treatment with full-dose or modified-dose anticoagulation. A total of 121 patients were enrolled at six hospitals. Seventy-five patients were initially treated with full-dose anticoagulation (62%), 33 (27%) with modified-dose anticoagulation, while 13 (11%) received no anticoagulation. Most patients who received modified-dose anticoagulation had a hematologic malignancy (31 of 33, 94%) and an acute DVT (28 of 33, 85%). In patients who initially received full-dose anticoagulation, the cumulative incidence of major hemorrhage at 60 days was 12.8% (95% CI, 4.9-20.8%) and 6.6% (95% CI, 2.4-15.7%) in those who received modified-dose anticoagulation (Fine-Gray HR 2.18, 95% CI 1.21-3.93). The cumulative incidence of recurrent VTE at 60 days in patients who initially received full-dose anticoagulation was 5.6% (95% CI, 0.2-11%) and 0% in patients who received modified-dose anticoagulation. In conclusion, modified-dose anticoagulation appears to be a safe alternative to therapeutic anticoagulation in patients with cancer who develop DVT in the setting of thrombocytopenia.

show abstract

“… 2 CIT affects ~10% to 38% of solid tumor cancer patients and ~40% to 68% of patients with hematologic malignancies. 3 CIT can result from treatment with cyclophosphamide or other alkylating agents. 2 These agents can negatively affect pluripotent stem cells and megakaryocyte progenitors, the precursors from which platelets proliferate, in bone marrow.…”

Section: Introductionmentioning

confidence: 99%

“… 2 Thrombocytopenia resulting from chemotherapy varies by treatment regimen; however, there is an 82% incidence of CIT in patients who receive carboplatin monotherapy. 3 Similar to carboplatin, temozolomide (TMZ) is an alkylating agent; thus, we can expect similar thrombocytopenic side effects. Especially in combination with radiotherapy, temozolomide has the potential to cause thrombocytopenia in newly diagnosed high-grade glioma patients.…”

Section: Introductionmentioning

confidence: 99%

A Case Study Using Papaya Leaf Extract to Reverse Chemotherapy-Induced Thrombocytopenia in a GBM Patient

et al. 2022

View full text Add to dashboard Cite

Chemotherapy-induced thrombocytopenia (CIT) is a critical condition in which platelet counts are abnormally reduced following the administration of chemotherapeutic compounds. CIT poses a treatment conundrum to clinicians given the increased risk of spontaneous bleeding, obstacles to surgical management of tumors, and exclusion from clinical trials. Treatment of CIT involves the removal of the offending agent combined with platelet infusion or thrombopoietin agonist treatment. However, due to the autoimmune and infection risks associated with infusions, this treatment is only reserved for patients with critically low platelet counts. One potential solution for patients in the mid to low platelet count range is Carica papaya leaf extract (CPLE). In this case, we report the novel use of CPLE as a method of bolstering platelet counts in a patient presenting with CIT. The patient was initiated on CPLE therapy consisting of 1 tablespoon twice daily with meals. Following CPLE treatment, the patient’s platelet counts rebounded from less than 10,000/µL to 113,000/µL. This clinical vignette supports the use of CPLE in the clinical context of CIT when thrombopoietin agonists are not a viable option. The potential benefits of CPLE as a method for increasing platelet count deserve further exploration, especially as a treatment option for refractory patients or those ill-suited for other traditional thrombocytopenia therapies.

show abstract

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

Cited by 45 publications

References 32 publications

Treatment of chemotherapy-induced thrombocytopenia in patients with non-hematologic malignancies

Treatment of chemotherapy-induced thrombocytopenia in patients with non-hematologic malignancies

Anticoagulation in cancer-associated thromboembolism with thrombocytopenia: a prospective, multicenter cohort study

A Case Study Using Papaya Leaf Extract to Reverse Chemotherapy-Induced Thrombocytopenia in a GBM Patient

Contact Info

Product

Resources

About