The impact of romiplostim use for chemotherapy induced thrombocytopenia on immediate and long-term outcomes in gynecologic malignancies.

OBJECTIVES

To describe the use of romiplostim, a thrombopoietin receptor agonist, to treat chemotherapy induced thrombocytopenia (CIT) in gynecologic malignancies.

METHODS

A retrospective study of patients with gynecologic malignancies who received romiplostim between 2008 and 2024 at a single institution. Response to romiplostim was defined as a platelet count of at least 75 × 109/L and an increase in platelet count by at least 30,000/μL 3-4 weeks after romiplostim initiation. Patient characteristics and outcomes were compared between responders and non-responders.

RESULTS

Of 147 patients, 107 (72.8 %) were responders. Pre-treatment mean platelet count (109/L) did not differ between responders and non-responders (81.2 vs 82.9, p = 0.81) but differed significantly three weeks after romiplostim initiation (200 vs 68.5, p < 0.001). At eight weeks after romiplostim initiation, platelet counts were similar (158 vs 151, p = 0.47). Responders were less likely to concurrently receive granulocyte colony stimulating factor (44.8 % vs 65.0 %, p = 0.040) and received a lower maximum dose (6.1 vs 7.3, p = 0.053). There were no differences in chemotherapy dose reductions (52.0 % vs 54.1 %, p = 0.850), treatment delays (days) (21 vs 17.5, p = 0.77), or overall survival (months) (61.4 vs 62.2, p = 0.926).

CONCLUSIONS

Most patients in this cohort had a rise in platelet count within 3-4 weeks of initiating romiplostim. Initial response to romiplostim was not associated with reduced dose adjustments, treatment delays, or overall survival. Romiplostim is an effective agent to overcome CIT in gynecologic malignancies, but its impact on oncologic outcomes requires further investigation in both pre-treated and chemotherapy naïve patients.