Eltrombopag treatment promotes platelet recovery and reduces platelet transfusion for patients with post-transplantation
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ORIGINAL ARTICLE
Eltrombopag treatment promotes platelet recovery and reduces platelet transfusion for patients with post-transplantation thrombocytopenia Fei Gao 1,2,3 & Xiaoyu Zhou 1,2,3 & Jimin Shi 1,2,3 & Yi Luo 1,2,3 & Yamin Tan 1,2,3 & Huarui Fu 1,2,3 & Xiaoyu Lai 1,2,3 & Jian Yu 1,2,3 & He Huang 1,2,3 & Yanmin Zhao 1,2,3 Received: 3 April 2020 / Accepted: 27 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Post-transplantation thrombocytopenia (PT) is a common and severe complication which usually leads to poor prognosis. Eltrombopag (EPAG), a novel oral thrombopoietin (TPO) receptor agonist, has shown promising effects in thrombocytopenia due to immune thrombocytopenic purpura (ITP) and refractory severe aplastic anemia (rSAA), while the effectiveness of EPAG for PT patients still needs to be evaluated. A total of 32 PT patients receiving EPAG were retrospectively analyzed between September 2017 and July 2019, including 15 patients with poor graft function (PGF) and 17 patients with secondary failure of platelet recovery (SFPR). To date, 21 (65.6%) patients achieved overall recovery (OR) and 14 (43.8%) patients achieved complete recovery (CR). Among responders, 18 (85.7%) patients discontinued or tapered the drug and 16 (76.2%) patients successfully maintained their best response. During the EPAG treatment, responders received much lower median platelet transfusion units than non-responders (11 vs. 95, P < 0.001). After a median follow-up time of 364 days (range, 24–842), the overall survival in these patients was 78.1% (100% for responders and 36.4% for non-responders, P < 0.001). In the univariate and multivariate analysis, PGF was identified as the independent risk factor for OR (P = 0.041, HR = 5.333). Megakaryocyte (Megk) amounts (P = 0.025, HR = 14.638) and splenomegaly (P = 0.042, HR = 11.278) were identified as independent risk factors for CR. Besides, PGF patients tended to take a longer time to achieve PR and CR than SFPR patients. In conclusion, our data suggest that EPAG can promote platelet recovery and reduce platelet transfusion in PT patients. Keywords Eltrombopag . Post-transplantation thrombocytopenia . Platelet recovery
Introduction Post-transplantation thrombocytopenia (PT) is a common and severe complication, which includes delayed platelet engraftment (DPE), secondary failure of platelet recovery (SFPR), * He Huang [email protected] * Yanmin Zhao [email protected] 1
Bone Marrow Transplantation Center, the First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003 Zhejiang, People’s Republic of China
2
Institute of Hematology, Zhejiang University, Hangzhou Zhejiang, People’s Republic of China
3
Zhejiang Engineering Laboratory for Stem Cell and Immunotherapy, Hangzhou Zhejiang, People’s Republic of China
and poor graft function (PGF). Studies have suggested that PT may be associated with low graft cell dose, graft versus host disease (GVHD), cytomegalovirus (CMV) infection, and drug-mediated platelet d
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