Use of eltrombopag, a thrombopoietin receptor agonist, in post‐transplantation thrombocytopenia

Abstract

using the STA-Compact instrument (Diagnostica Stago, Parsippany, NJ) was used to quantify anti-Factor Xa (LMWH) activity for enoxaparin. The sensitivity of this assay is 0.2 U/mL and within run imprecision is 5.5 (% CV) at 1 U/mL. The assay is linear between 0.2 and 2.0 U/mL. All anti-Factor Xa levels were analyzed by technicians blinded to the assigned treatment regimen. The target range for peak anti-Factor Xa levels was chosen to be 0.2-0.5 IU/mL [14].Statistical analyses.. The sample size for this pilot study was chosen to provide a cohort large enough to identify differences between groups, based on previous studies [17]. Descriptive statistics were used to calculate summary data. Data are represented as the mean ± SD, unless otherwise indicated. For all analyses, continuous variables were assessed for normality visually and with skewness and kurtosis tests (version 11.0, StataCorp, College Station, TX 77845). Parametric, two-tailed t-tests or ANOVA were used for continuous variables and the chi-square and Fisher's exact test for categorical variables with a predetermined alpha level of P < 0.05. Stepwise, multiple regression analyses were used to identify any pre-specified variables potentially affecting peak anti-Factor Xa levels, including age, actual body weight, BMI, time (enoxaparin dose administration to anti-Factor Xa measurements), gender, or estimated creatinine clearance. AcknowledgmentsAuthors thank all the patients that agreed to participate in this study, Ms. Pam Proctor and Linda Kelly for their research oversight, Dr. Chris Lehman for his assistance with anti-Factor Xa measurements, and Diana Lim for her assistance with illustrations and tables.

Usefulness of thrombopoietin receptor agonists for persistent clinically relevant thrombocytopenia after allogeneic stem cell transplantation

“…Although these publications may suffer from publication bias of positive outcomes, overall they show promising results. [8][9][10][11][12][13][14][15] In this preliminary study in which we recruited 20 alloSCT recipients with posttransplant severe thrombocytopenia, we have tried to perform a careful and thoughtful descriptive analysis to emphasize the importance to keep working on improving the treatment in common and relevant post-SCT complications.…”

“…7 However, the reported experience on their use after alloSCT is currently limited. [8][9][10][11][12][13][14][15] In this study, we retrospectively evaluated TPOa efficacy and safety in 20 consecutive adult alloSCT recipients who received either romiplostim or eltrombopag as a compassionate use for treating severe thrombocytopenia postengraftment in alloSCT recipients, exploring the potential predictive factors of response in this cohort.…”

Immune thrombocytopenia – what are the new treatment options?

“…This includes supporting patients who develop thrombocytopenia following myelosuppressive chemotherapy, radiotherapy or conditioning for haematopoietic stem cell transplantation. TPO receptor agonists might reduce the need for platelet transfusion support and the significant morbidity and uncommon but devastating mortality associated with haemorrhage in these individuals who are usually at higher risk of clinically serious bleeding at any particular platelet count than those with ITP [119,120]. Outside of haematological disease, romiplostim has already been reported to be of benefit in augmenting platelet counts in the context of liver cirrhosis in hepatitis C infection, so permitting sustained full-dose and effective IFN-based therapy and has now been approved by the FDA for this indication [121,122].…”

The role of eltrombopag in the management of hepatitis C virus-related thrombocytopenia

“…The drug has recently been used successfully in two cases of persistently thrombocytopenic, platelet transfusion-dependent patients following stem-cell transplantations (one allogeneic and one autologous) 76. In both cases, the patients became platelet-transfusion independent with a platelet count of ~30,000 and ~10,000/mm 3 , respectively, within ~2 weeks of starting eltrombopag treatment.…”