Use of Eltrombopag in Patients with Platelet Engraftment Failure Following Second Allogeneic Peripheral Stem Cell Transplantation

Aliye Serpil Sarıfakıoğulları; Melya Pelin Kırık; Salih Sertaç Durusoy; Handan Haydaroğlu Şahin; İlknur Gündeş; Mustafa Pehlivan

doi:10.5152/EurJTher.2017.234

Authors

Aliye Serpil Sarıfakıoğulları Department of Hematology, Gaziantep University School of Medicine, Gaziantep https://orcid.org/0000-0002-6523-0996
Melya Pelin Kırık Department of Internal Medicine, Gaziantep University School of Medicine, Gaziantep https://orcid.org/0000-0002-0699-1330
Salih Sertaç Durusoy Department of Hematology, Gaziantep University School of Medicine, Gaziantep https://orcid.org/0000-0002-3577-6330
Handan Haydaroğlu Şahin Department of Hematology, Gaziantep University School of Medicine, Gaziantep https://orcid.org/0000-0002-3467-8819
İlknur Gündeş Department of Internal Medicine, Gaziantep University School of Medicine, Gaziantep https://orcid.org/0000-0003-3940-6705
Mustafa Pehlivan Department of Hematology, Gaziantep University School of Medicine, Gaziantep, Turkey; Bone Marrow Transplantation Centre, Gaziantep University School of Medicine, Gaziantep https://orcid.org/0000-0002-6692-085X

DOI:

https://doi.org/10.5152/EurJTher.2017.234

Keywords:

Allogeneic peripheral stem cell transplantation, eltrombopag, prolonged thrombocytopenia

Abstract

Thrombocytopenia after peripheral stem cell transplantation (PSCT) is associated with morbidity and mortality. Eltrombopag, a thrombopoietin receptor agonist, is successfully used primarily in the treatment of chronic idiopathic thrombocytopenic purpura and other thrombocytopenias associated with aplastic anemia and myelodysplastic syndrome. Recently, the use of eltrombopag in the treatment of thrombocytopenia after allogeneic PSCT has shown promising results. The use of eltrombopag in three patients with hematologic malignancy who experienced graft failure after the first PSCT and developed platelet engraftment failure following the second bone marrow (BM) transplantation was presented retrospectively. The patients included two males and one female, with the mean age of 52 (45–57) years. The diagnoses were acute myeloid leukemia, non-hodgkin lymphoma (NHL), acute lymphocytic leukemia. All patients underwent allogeneic PSCT with the myeloablative regimen. Platelet engraftment failure was detected during the follow-up of the patients. Acute grade 3 skin graft versus host disease developed in the patient with NHL. Mycophenolate-mofetil, cyclosporin-A, steroid-based immunosuppression therapy was given. Graft versus host disease completely responded to this treatment in the first week of treatment. However, thrombocytopenia persisted. None of the patients had any viral infection or relapse. BM biopsies of patients were hypocellular, and the number of megakaryocytes were found to be decreased. Eltrombopag was initiated in three patients after 110 (60–144) days of transplantation. Responses were obtained in all of the patients; the platelet value was ≥30 × 103 /µL (30.000–247.000). The mean duration of response was 27 (20–35) days. Although engraftment failure is not a routine indication of the eltrombopag, it can be used safely and effectively in patients with platelet engraftment failure after PSCT.

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