title: Evaluation of romiplostim for the treatment of secondary failure of platelet recovery among allogeneic hematopoietic stem cell transplant patients.
abstract: Secondary failure of platelet recovery (SFPR) is a serious complication observed in approximately 20% of allogeneic hematopoietic stem cell transplant (HSCT) recipients. Although the standard therapeutic approach has been frequent platelet transfusions, romiplostim, a thrombopoietin receptor agonist, may have utility in treating SFPR. The primary objective of this single-center retrospective analysis was to assess effectiveness of romiplostim for SFPR and to evaluate patient factors which may influence clinical outcomes. The primary outcome measure of response was defined as achievement of platelet count ≥ 50 × 109/L without transfusions for ≥ 7 consecutive days. During the study period, 93 patients underwent HSCT and 13 (13.9%) received romiplostim for SFPR. Seven patients (53.8%) responded to romiplostim, requiring a median of three doses (range 1-6) to achieve independence from platelet transfusions. Disease relapse occurred in 38.5% of all patients, two responders and three nonresponders. Median survival post-HSCT was 753 days among responders and 266 days among nonresponders ( p = 0.0375). No serious adverse events were reported, and rates of graft-versus-host disease did not increase following administration of romiplostim. Thrombopoietin receptor agonists including romiplostim offer a treatment option for persistent thrombocytopenia following HSCT. Positive clinical response to romiplostim post-HSCT is associated with improved outcomes.
authors.affiliation: 1 Department of Pharmacy Practice, Rosalind Franklin University of Medicine and Science College of Pharmacy, North Chicago, IL, USA.|2 Department of Pharmacy, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Hartranft
authors.affiliation: 3 Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Augusta, GA, USA.|4 Georgia Regents University Cancer Center, Augusta, GA, USA.
authors.forename: Amber B
authors.initials: AB
authors.lastname: Clemmons
authors.affiliation: 3 Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Augusta, GA, USA.|4 Georgia Regents University Cancer Center, Augusta, GA, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: DeRemer
authors.affiliation: 5 Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Vamsi
authors.initials: V
authors.lastname: Kota
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001792:Blood Platelets / Q000187:drug effects*; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000378:metabolism; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count / Q000379:methods; D011961:Receptors, Fc / Q000627:therapeutic use*; D053628:Receptors, Thrombopoietin / Q000378:metabolism; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use*; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000188:drug therapy / Q000378:metabolism; D013926:Thrombopoietin / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D011961:Receptors, Fc; D053628:Receptors, Thrombopoietin; D011993:Recombinant Fusion Proteins; D013926:Thrombopoietin; C488777:romiplostim
keywords: Thrombocytopenia; allogeneic hematopoietic stem cell transplant; romiplostim; secondary failure of platelet recovery; thrombopoietin receptor agonist