[Successful treatment with fostamatinib and eltrombopag in a patient with refractory chronic immune thrombocytopenia].

A 52-year-old man with a history of hypertension developed chronic immune thrombocytopenia (cITP) in 2006. After a transient response to steroid therapy, thrombocytopenia relapsed and was refractory to splenectomy, eltrombopag (EPAG), and rituximab treatment. The patient subsequently received kamikihito and cepharanthine combined with EPAG. However, this treatment was ineffective, and the platelet count remained between 2,000 and 20,000/µl. The patient had occasional gastrointestinal bleeding in addition to subcutaneous bleeding and oral hematoma. EPAG was discontinued, and fostamatinib (150 mg/day) was initiated in May 2023. The platelet count increased to 68,000/µl at 2 weeks after starting fostamatinib, but decreased again during the fourth week of treatment. The maximum fostamatinib dose was ineffective during the eighth week, and thus EPAG (25 mg/day) was added to the therapeutic regimen. The platelet count increased to 114,000/µl at 2 weeks after that point, and remained at that level after 9 months of combination therapy. We observed a synergistic effect between fostamatinib and EPAG, which suggests that combination therapy may be effective for refractory cITP.