Thrombopoietin Receptor Agonist (ELTROMBOPAG) for Chronic Immune Thrombocytopenic Purpura (ITP) Treatment: 21 Patients in Only One Center

Abstract

AbstractAbstract 4658 IntroductionITP management has changed since thrombopoietin receptor agonists (TRAs) were approved for its treatment. Current TRAs are recommended for adults at risk of bleeding who relapse after splenectomy, as well as for those where splenectomy is contraindicated and where, at least, one other therapy has failed.The goal of this paper is to present the results of the treatment and follow-up of 21 patients treated with Eltrombopag in our Centre during the last year. PatientsWe present 21 patients diagnosed with chronic ITP according to the American Society of Hematology guidelines. 7 of them were males and 14 females. The median age was 70 years (range from 26 to 81 years). Previous splenectomy was undergone in 3 patients. 10 patients had previously received two or more therapies for ITP. 11 patients received TRAs as second line treatment. ResultsOn average, platelet counts at the beginning of the treatment with Eltrombopag were 23.000/μL. All patients started with the same doses (50 mg) except one of them who started with 25 mg. Patients only received concurrent ITP therapy (corticosteroids and intravenous immunoglobulins) when platelet counts were under 20,000/μL or bleeding occurred.8 patients needed rescue medications throughout the treatment with Eltrombopag (7 of them only once). Eltrombopag was withdrawn in a total number of 8 patients due to different reasons: 4 patients were considered as non-responders (3 of them didn't achieve a certain platelet count to prevent major bleeding and, in the fourth one, reducing or suspending the concurrent ITP therapy was not possible. One of these non-responders received Romiplostin and a good response was achieved). In one patient, the therapy was withdrawn due to liver toxicity and in another one, at patient's request. Finally, Eltrombopag was withdrawn in 2 patients because a sustained platelet counts was held. ConclusionTRAs are safe, effective and well-tolerated for those patients who relapse after splenectomy or when splenectomy is contraindicated. In our experience, TRAs could be also useful in other diseases like HCV or HIV associated thrombocytopenia. Eltrombopag and Romiplostin bind in different places to the TPO receptor (TPO-R). This circumstance, together with the different activation pathways, may explain that some non-responders to Eltrombopag could respond to Romiplostin and viceversa.PatientAgeComorbiditiesPrevious treatmentFollow upSide effecsResponse181Atrial Fibrillation High blood pressure (HBP)PRD, IVIG, Azathioprine6 mOedema peripheral dizzinessWithdraw/Intolerance243Thyroid cancer (CR)PRD, IVIG7 mNoneSustained338HCV+PRD, IVIG Azathioprine Splenectomy1 y 4mNoneSustained479HBP Breast cancer (CR)PRD, IVIG11 mDry mouthSustained526AVN of the femoral headPRD, IVIG6 mNoneSustained672COPD. DM. Heart attack. Aortocoronary bypassPRD,IVIG11 m 15 dNoneSustained773HysterectomyPRD, IVIG, Rituximab, Romiplostim6 mNoneSustained839NonePRD e IgG7 mNoneSustained980HBP. AsthmaPRD. IVIG Romiplostim5 mNoneSustained1052NonePRD, IVIG4 mNoneSustained1170HBP. DM. Stroke (2004) Multinodular goiter.PRD, IVIG, dapsona, Splenectomy3 m 15 dDiarrheaSustained/Withdraw1278HBP. DM. Bypass F-T, Leg Amputation, GlaucomaPRD, IVIG2 m y 7 dHepatotoxicityWithdraw/Toxicity1377VCIPRD, IVIG3 mNoneWithdraw/NR1481HBP. Stroke (1999) Prostate carcinoma (CR)PRD, IVIG4 mNoneSustained1581HBPPRD, IVIG, Romiplostim1 m 15 dNoneWithdraw/NR1639VCI. Chronic atrophic gastritisPRD, IVIG y Rituximab2 mNoneWithdraw/NR1775Chronic renal failurePRD, IVIG15 dNoneSustained1825NonePRD, DXM, IVIG, Rituximab, Splenectomy11 mNoneSustained1954NonePRD, IVIG Azathioprine Splenectomy Rituximab3 mNoneWithdraw/NR2042NonePRD, IVIG, Rituximab11 mNoneSustained2147HIV+PRD, IVIG6 mNoneSustained/WithdrawHBP: High blood pressure. PRD: prednisone. IgG: intravenous immunoglobulins. CR: complete response. NR: non response. AVN: Avascular necrosis. COPD: chronic obstructive pulmonary disease. DM: diabetes mellitus. Bypass femoro-tibial. VCI: variable common immunodeficiency. DXM: Dexamethasone. Disclosures:No relevant conflicts of interest to declare.