Eltrombopag for the Treatment of Poor Graft Function Following Haematopoietic Cell Transplantation: Real-Life Data

Eltrombopag has an off-label indication for haematopoietic cell transplantation in patients experiencing delayed thrombocyte recovery and/or thrombocytopaenia. To present our centre’s experience of using this agent not only for post- haematopoietic cell transplantation thrombocytopaenia but also for...

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Published in:Balkan medical journal Vol. 40; no. 1; pp. 51 - 56
Main Authors: Kırcalı, Ekin, Cengiz Seval, Güldane, Öztürk, Cemaleddin, Yılmaz, Hülya, Koyun, Derya, Civriz Bozdağ, Sinem, Toprak, Selami Koçak, Topçuoğlu, Pervin, Arslan, Önder, Özcan, Muhit, Demirer, Taner, İlhan, Osman, Gürman, Günhan, Beksaç, Meral, Kurt Yüksel, Meltem
Format: Journal Article
Language:English
Published: Turkey Galenos Yayinevi Tic. Ltd 01-01-2023
Galenos Publishing
Galenos Publishing House
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Summary:Eltrombopag has an off-label indication for haematopoietic cell transplantation in patients experiencing delayed thrombocyte recovery and/or thrombocytopaenia. To present our centre’s experience of using this agent not only for post- haematopoietic cell transplantation thrombocytopaenia but also for poor graft functioning in the post-haematopoietic cell transplantation setting. Retrospective cross-sectional study. Thirty-nine patients who had persistent cytopaenia following haematopoietic cell transplantation and treated with eltrombopag at our centre between October 2011 and December 2021 were retrospectively identified. During this period, 9 (23.1%) and 30 (76.9%) patients who underwent allogeneic transplantations, respectively, received eltrombopag. The female-to-male ratio was 12:27, and the median transplant age was 49 (18-70) years. Eight (20.5%) patients had isolated thrombocytopaenia, 19 (49.4%) had bi-lineage cytopaenia and 12 (30.1%) had pancytopaenia. Patients received a median of 50 mg/day (25-150 mg/day) of eltrombopagfor a median duration of 82 (24-386) days. Nine (23.1%) patients had autologous haematopoietic cell transplantation, and 30 (76.9%) had allogeneic haematopoietic cell transplantation (14 unrelated, 9 sibling and 7 haploidentical). The median donor age was 32 (20-67) years. The median follow-up was 16.4 (1.8-84.3) months. The median pre-treatment platelet count was 11x10 /l (1-23), which increased to 41x10 /l (6-150). The median platelet count increment was 29.5x10 /l ( = 0.001). The pre-treatment median neutrophil count was 1.19x10 /l (0.39-5.1), which increased to 2.35 x10 /l (0.1-5.33) ( = 0.05), and the pre-treatment median haemoglobin was 8.3 (6.2-14) g/dl, which increased to 10 (6.2-14) g/dl ( = 0.001) with eltrombopag. No eltrombopag-related hepatotoxicity occurred; however, 1 (2.6%) patient failed to continue treatment because of two consecutive episodes of deep venous thrombosis. Six (15.4%) patients were unresponsive to eltrombopag and dependent on blood product transfusions. After a median time of 82 days, 61.5% of the patients discontinued eltrombopag successfully. The results confirmed that eltrombopag could provide a rapid, sustained response in patients with poor graft functioning after haematopoietic cell transplantation. This finding is essential given the high rate of non-relapse mortality caused by poor graft functioning after haematopoietic cell transplantation.
ISSN:2146-3123
2146-3131
DOI:10.4274/balkanmedj.galenos.2022.2022-2-48