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Usefulness of eltrombopag for treating thrombocytopenia after allogeneic stem cell transplantation

Bone Marrow Transplantation volumeĀ 54,Ā pages 757ā€“761 (2019)Cite this article

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Prolonged isolated thrombocytopenia (PT) and secondary failure of platelet recovery (SFPR) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) are well-known complications that can lead to potentially lethal bleeding. PT was defined as the engraftment of all peripheral blood cell lines but with a platelet countsā€‰<ā€‰20ā€‰Ć—ā€‰109/L or dependence on platelet transfusions for >60 days after allo-HSCT [1]. In contrast, SFPR was defined as a decline in platelet count toā€‰<ā€‰20ā€‰Ć—ā€‰109/L for 7 consecutive days, or a requirement for transfusion support after achieving a sustained platelet countā€‰ā‰„ā€‰50ā€‰Ć—ā€‰109/L without transfusions for 7 consecutive days post-HSCT [2]. Previous studies have reported an incidence of SFPR between 12 and 20% and PT is around 20ā€“40% [1, 2]. Currently, there are no specific guidelines for its treatment and platelet transfusion is the standard of care in this setting. However, transfusion support is associated with several adverse events, such as infusion reactions, platelet refractoriness, acute lung injury, cardiac failure due to volume overload, and viral transmission, all of which impose a heavy financial burden [3]. Eltrombopag is effective and safe for treating primary immune thrombocytopenia (ITP) [4], and other conditions such as aplastic anemia [5]. In this letter, we described the characteristics our series of patients who were given eltrombopag for PT and SFPR after allo-HSCT.

We retrospectively studied of 467 patients who underwent allo-HSCT between November 2010 and March 2017 in our center. Eltrombopag was given to 14 patients with severe thrombocytopenia after allo-HSCT as compassionate use. Before starting eltrombopag, a bone marrow (BM) aspirate was collected in order to evaluate the number of megakaryocytes. All patients were in complete remission (CR), with full BM chimerism. In addition, none of them had thrombotic microangiopathy. Eltrombopag was started at a dose of 50ā€‰mg once daily with dose escalation at a rate of 50ā€‰mg weekly to a maximum of 150ā€‰mg/day [6]. This study was conducted in accordance with the Declaration of Helsinki and approved by the Local Hospital Ethics Committee.

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Acknowledgements

We gratefully acknowledge the patient and her family members. We are grateful to Dr Phil Mason for his attention to some technical aspects. JMB was partially supported by grants from the Instituto de Salud Carlos III (ISCIII) (PI 17/01966).

Author contributions

All authors contributed to the conception and design of the study, the acquisition, analysis and interpretation of the data, drafting the manuscript, and critically revising it for important intellectual content. All authors approved the final version for publication.

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Author notes

  1. These authors contributed equally: D. Rivera, J.M. Bastida.

Authors and Affiliations

  1. Department of Hematology, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain

    D. Rivera,Ā J. M. Bastida,Ā L. Lopez-Corral,Ā F. Sanchez-Guijo,Ā M. Cabrero,Ā A. Martin,Ā E. Perez,Ā M. Lopez-Parra,Ā A. AvendaƱo,Ā A. Veiga,Ā M. Baile,Ā N. Arratibel,Ā J. Carrillo,Ā L. Vazquez,Ā M. D. CaballeroĀ &Ā J. R. Gonzalez-Porras

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  1. D. Rivera
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Correspondence to J. M. Bastida.

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Rivera, D., Bastida, J.M., Lopez-Corral, L. et al. Usefulness of eltrombopag for treating thrombocytopenia after allogeneic stem cell transplantation. Bone Marrow Transplant 54, 757ā€“761 (2019). https://doi.org/10.1038/s41409-018-0368-1

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