Efficacy of eltrombopag in combination with recombinant human thrombopoietin (rhTPO) for lymphoma patients with chemotherapy-induced thrombocytopenia.

PURPOSE: To observe the efficacy and adverse reactions of eltrombopag combined with rhTPO in the treatment of lymphoma patients with chemotherapy - induced thrombocytopenia (CIT).

METHODS

A retrospective study was performed on the clinical data of 61 patients using eltrombopag (75 mg once a day), 99 patients using rhTPO (15,000 U once daily), and 50 patients using eltrombopag (75 mg once a day) combined with rhTPO (15,000 U once daily) in the treatment of lymphoma with CIT at the First Affiliated Hospital of Guangdong Pharmaceutical University from April 2017 to May 2022.66 patients with lymphoma after chemotherapy without any platelet-stimulating therapy were selected as observation controls. Administration of rhTPO and/or eltrombopag was initiated concurrently when the platelet count dropped below 50 × 109/L. The primary outcome measures encompassed platelet recovery, treatment duration, bleeding events, platelet transfusion requirements, and adverse events. Eltrombopag and rhTPO were discontinued when platelet count was more than 100 × 109/L.

RESULTS

Pre-chemotherapy platelet count did not differ significantly among the three groups (eltrombopag, rhTPO, and combination), as indicated by P > 0.05. At day 5, mean platelet counts were (54.18 ± 20.63)×109/L (eltrombopag) (56.01 ± 28.51)×109/L (rhTPO) (68.90 ± 24.73)×109/L (combination), and (32.70 ± 15.86)×109/L (control). The combination therapy achieved significantly higher values than control (P < 0.001), rhTPO (P = 0.025), and eltrombopag (P = 0.042), while both monotherapies also showed significant elevations relative to control (both P < 0.001). At day 10, the combination group (166.30 ± 62.37 ×109/L) exhibited a significantly higher platelet count than the control (71.91 ± 42.12, P < 0.001), the rhTPO group (143.31 ± 112.45, P = 0.015), and the eltrombopag group (123.75 ± 47.90, P = 0.036). All three treatment groups demonstrated a significantly lower bleeding incidence versus the control group. The combination group had the lowest proportion of platelet transfusion units per patient (32.0%), whereas the control group had the highest (72.7%), with the eltrombopag and rhTPO groups showing intermediate rates (54.1% and 50.5%, respectively). All three treatment regimens exhibited adverse events that were mild in severity and clinically acceptable.

CONCLUSION

Eltrombopag combined with rhTPO is a effective and safe treatment for lymphoma with CIT, and the effect of the combination is better than that of eltrombopag or rhTPO alone.