Abstract

Abstract 4658

Introduction

ITP management has changed since thrombopoietin receptor agonists (TRAs) were approved for its treatment. Current TRAs are recommended for adults at risk of bleeding who relapse after splenectomy, as well as for those where splenectomy is contraindicated and where, at least, one other therapy has failed.

The goal of this paper is to present the results of the treatment and follow-up of 21 patients treated with Eltrombopag in our Centre during the last year.

Patients

We present 21 patients diagnosed with chronic ITP according to the American Society of Hematology guidelines. 7 of them were males and 14 females. The median age was 70 years (range from 26 to 81 years). Previous splenectomy was undergone in 3 patients. 10 patients had previously received two or more therapies for ITP. 11 patients received TRAs as second line treatment.

Results

On average, platelet counts at the beginning of the treatment with Eltrombopag were 23.000/μL. All patients started with the same doses (50 mg) except one of them who started with 25 mg. Patients only received concurrent ITP therapy (corticosteroids and intravenous immunoglobulins) when platelet counts were under 20,000/μL or bleeding occurred.

8 patients needed rescue medications throughout the treatment with Eltrombopag (7 of them only once). Eltrombopag was withdrawn in a total number of 8 patients due to different reasons: 4 patients were considered as non-responders (3 of them didn't achieve a certain platelet count to prevent major bleeding and, in the fourth one, reducing or suspending the concurrent ITP therapy was not possible. One of these non-responders received Romiplostin and a good response was achieved). In one patient, the therapy was withdrawn due to liver toxicity and in another one, at patient's request. Finally, Eltrombopag was withdrawn in 2 patients because a sustained platelet counts was held.

Conclusion

TRAs are safe, effective and well-tolerated for those patients who relapse after splenectomy or when splenectomy is contraindicated. In our experience, TRAs could be also useful in other diseases like HCV or HIV associated thrombocytopenia. Eltrombopag and Romiplostin bind in different places to the TPO receptor (TPO-R). This circumstance, together with the different activation pathways, may explain that some non-responders to Eltrombopag could respond to Romiplostin and viceversa.

PatientAgeComorbiditiesPrevious treatmentFollow upSide effecsResponse
1 81 Atrial Fibrillation High blood pressure (HBP) PRD, IVIG, Azathioprine 6 m Oedema peripheral dizziness Withdraw/Intolerance 
2 43 Thyroid cancer (CR) PRD, IVIG 7 m None Sustained 
3 38 HCV+ PRD, IVIG Azathioprine Splenectomy 1 y 4m None Sustained 
4 79 HBP Breast cancer (CR) PRD, IVIG 11 m Dry mouth Sustained 
5 26 AVN of the femoral head PRD, IVIG 6 m None Sustained 
6 72 COPD. DM. Heart attack. Aortocoronary bypass PRD,IVIG 11 m 15 d None Sustained 
7 73 Hysterectomy PRD, IVIG, Rituximab, Romiplostim 6 m None Sustained 
8 39 None PRD e IgG 7 m None Sustained 
9 80 HBP. Asthma PRD. IVIG Romiplostim 5 m None Sustained 
10 52 None PRD, IVIG 4 m None Sustained 
11 70 HBP. DM. Stroke (2004) Multinodular goiter. PRD, IVIG, dapsona, Splenectomy 3 m 15 d Diarrhea Sustained/Withdraw 
12 78 HBP. DM. Bypass F-T, Leg Amputation, Glaucoma PRD, IVIG 2 m y 7 d Hepatotoxicity Withdraw/Toxicity 
13 77 VCI PRD, IVIG 3 m None Withdraw/NR 
14 81 HBP. Stroke (1999) Prostate carcinoma (CR) PRD, IVIG 4 m None Sustained 
15 81 HBP PRD, IVIG, Romiplostim 1 m 15 d None Withdraw/NR 
16 39 VCI. Chronic atrophic gastritis PRD, IVIG y Rituximab 2 m None Withdraw/NR 
17 75 Chronic renal failure PRD, IVIG 15 d None Sustained 
18 25 None PRD, DXM, IVIG, Rituximab, Splenectomy 11 m None Sustained 
19 54 None PRD, IVIG Azathioprine Splenectomy Rituximab 3 m None Withdraw/NR 
20 42 None PRD, IVIG, Rituximab 11 m None Sustained 
21 47 HIV+ PRD, IVIG 6 m None Sustained/Withdraw 
PatientAgeComorbiditiesPrevious treatmentFollow upSide effecsResponse
1 81 Atrial Fibrillation High blood pressure (HBP) PRD, IVIG, Azathioprine 6 m Oedema peripheral dizziness Withdraw/Intolerance 
2 43 Thyroid cancer (CR) PRD, IVIG 7 m None Sustained 
3 38 HCV+ PRD, IVIG Azathioprine Splenectomy 1 y 4m None Sustained 
4 79 HBP Breast cancer (CR) PRD, IVIG 11 m Dry mouth Sustained 
5 26 AVN of the femoral head PRD, IVIG 6 m None Sustained 
6 72 COPD. DM. Heart attack. Aortocoronary bypass PRD,IVIG 11 m 15 d None Sustained 
7 73 Hysterectomy PRD, IVIG, Rituximab, Romiplostim 6 m None Sustained 
8 39 None PRD e IgG 7 m None Sustained 
9 80 HBP. Asthma PRD. IVIG Romiplostim 5 m None Sustained 
10 52 None PRD, IVIG 4 m None Sustained 
11 70 HBP. DM. Stroke (2004) Multinodular goiter. PRD, IVIG, dapsona, Splenectomy 3 m 15 d Diarrhea Sustained/Withdraw 
12 78 HBP. DM. Bypass F-T, Leg Amputation, Glaucoma PRD, IVIG 2 m y 7 d Hepatotoxicity Withdraw/Toxicity 
13 77 VCI PRD, IVIG 3 m None Withdraw/NR 
14 81 HBP. Stroke (1999) Prostate carcinoma (CR) PRD, IVIG 4 m None Sustained 
15 81 HBP PRD, IVIG, Romiplostim 1 m 15 d None Withdraw/NR 
16 39 VCI. Chronic atrophic gastritis PRD, IVIG y Rituximab 2 m None Withdraw/NR 
17 75 Chronic renal failure PRD, IVIG 15 d None Sustained 
18 25 None PRD, DXM, IVIG, Rituximab, Splenectomy 11 m None Sustained 
19 54 None PRD, IVIG Azathioprine Splenectomy Rituximab 3 m None Withdraw/NR 
20 42 None PRD, IVIG, Rituximab 11 m None Sustained 
21 47 HIV+ PRD, IVIG 6 m None Sustained/Withdraw 

HBP: High blood pressure. PRD: prednisone. IgG: intravenous immunoglobulins. CR: complete response. NR: non response. AVN: Avascular necrosis. COPD: chronic obstructive pulmonary disease. DM: diabetes mellitus. Bypass femoro-tibial. VCI: variable common immunodeficiency. DXM: Dexamethasone.

Disclosures:

No relevant conflicts of interest to declare.

Author notes

*

Asterisk with author names denotes non-ASH members.