Thrombopoietin Receptor Agonists for Severe Thrombocytopenia after Allogeneic Stem Cell Transplantation : Experience of the Spanish Group of Hematopoietic Stem Cell Transplant
Bento, Leyre (Instituto de Investigación Sanitaria Islas Baleares)
Bastida, José María (Hospital Universitario de Salamanca)
Garcia Cadenas, Irene (Institut d'Investigació Biomèdica Sant Pau)
García-Torres, Estefania (Hospital Universitario Reina Sofía (Córdoba, Espanya))
Rivera, Daniel (Hospital Universitario de Salamanca)
Bosch-Vilaseca, Anna (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
De Miguel, Carlos (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))
Martínez-Muñoz, María Esther (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))
Fernandez Aviles, Francesc (Hospital Clínic i Provincial de Barcelona)
Roldán Galvan, Elisa (Hospital Universitari Vall d'Hebron)
Chinea, Anabelle (Hospital Universitario Ramón y Cajal (Madrid))
Yáñez, Lucrecia (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Zudaire, Teresa (Complejo Hospitalario de Navarra)
Vaz, Carlos Pinho (Instituto Português de Oncologia)
Espigado, Ildefonso (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
López, Javier (Hospital Universitario Ramón y Cajal (Madrid))
Valcárcel, David (Hospital Universitari Vall d'Hebron)
Duarte, Rafael (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))
Cabrera, Rafael (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))
Herrera, Concepción (Hospital Universitario Reina Sofía (Córdoba, Espanya))
González-Porras, José Ramón (Hospital Universitario de Salamanca)
Gutiérrez, Antonio (Instituto de Investigación Sanitaria Islas Baleares)
Solano, Carlos (Hospital Clínic Universitari (València))
Sampol, Antonia (Instituto de Investigación Sanitaria Islas Baleares)
Universitat Autònoma de Barcelona

Data:	2019
Resum:	Persistent thrombocytopenia is a common complication after allogeneic hematopoietic stem cell transplantation (allo-SCT). Romiplostim and eltrombopag are the currently available thrombopoietin receptor agonists (TPO-RAs), and some studies with very small numbers of cases have reported their potential efficacy in the allo-SCT setting. The present retrospective study evaluated the safety and efficacy of TPO-RAs in 86 patients with persistent thrombocytopenia after allo-HSCT. Sixteen patients (19%) had isolated thrombocytopenia (PT), and 71 (82%) had secondary failure of platelet recovery (SFPR). TPO-RA therapy was started at a median of 127 days (range, 27 to 1177 days) after allo-SCT. The median initial and maximum administered doses were 50 mg/day (range, 25 to 150 mg/day) and 75 mg/day (range, 25 to 150 mg/day), respectively, for eltrombopag and 1 µg/kg (range, 1 to 7 µg/kg) and 5 µg/kg (range, 1 to 10 µg/kg), respectively, for romiplostin. The median platelet count before initiation of TPO-RA therapy was 14,000/µL (range, 1000 to 57,000/µL). Platelet recovery to ≥50,000/µL without transfusion support was achieved in 72% of patients at a median time of 66 days (range, 2 to 247 days). Eighty-one percent of the patients had a decreased number of megakaryocytes before treatment, showing a slower response to therapy (P =. 011). The median duration of treatment was 62 days (range, 7 to 700 days). Grade 3-4 adverse events (hepatic and asthenia) were observed in only 2% of the patients. At last follow-up, 81% of patients had discontinued TPO-RAs and maintained response, and 71% were alive. To our knowledge, this is the largest series analyzing the use of TPO-RAs after allo-SCT reported to date. Our results support the efficacy and safety in this new setting. Further prospective trials are needed to increase the level of evidence and to identify predictors of response.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Allogeneic stem cell transplantation ; Thrombocytopenia ; Thrombopoietin receptor agonists
Publicat a:	Biology of blood and marrow transplantation, Vol. 25 Núm. 9 (september 2019) , p. 1825-1831, ISSN 1523-6536

DOI: 10.1016/j.bbmt.2019.05.023
PMID: 31152794

7 p, 1.0 MB

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