Use of Eltrombopag in Improving Poor Graft Function after Allogeneic Hematopoietic Stem Cell Transplantation

Eltrombopag is a thrombopoietin agonist and has been used in aplastic anemia and post-transplantation thrombocytopenia. The c-MPL receptor is present on hematopoietic stem cells. There are no reports of eltrombopag utilization for improving poor graft function in the post-transplant setting. Here were report a case of a young female with post-transplant poor graft function as evident from the low absolute neutrophil count, anemia, and thrombocytopenia on day 60. Eltrombopag was started on day 72 and resulted in improvement in all 3 cell lines. The counts continued to be stable even after eltrombopag was discontinued. The patient tolerated the drug without significant side effects for 1 year.

[1]  Y. Kwong,et al.  The thrombopoietin mimetics eltrombopag and romiplostim in the treatment of refractory aplastic anaemia , 2017, British journal of haematology.

[2]  A. Clemmons,et al.  Evaluation of romiplostim for the treatment of secondary failure of platelet recovery among allogeneic hematopoietic stem cell transplant patients , 2017, Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners.

[3]  C. Jung,et al.  Efficacy and Safety of Romiplostim in Patients with Aplastic Anemia Refractory to Immunosuppressive Therapy: 1-Year Interim Analysis of Phase 2 Clinical Trial , 2016 .

[4]  D. Allan,et al.  Eltrombopag after allogeneic haematopoietic cell transplantation in a case of poor graft function and systematic review of the literature , 2016, Transfusion medicine.

[5]  U. Popat,et al.  Romiplostim for delayed platelet recovery and secondary thrombocytopenia following allogeneic stem cell transplantation. , 2013, American journal of blood research.

[6]  D. Signorelli Eltrombopag and Improved Hematopoiesis in Refractory Aplastic Anemia , 2013 .

[7]  Yuhchyau Chen,et al.  Eltrombopag, a thrombopoietin receptor agonist, enhances human umbilical cord blood hematopoietic stem/primitive progenitor cell expansion and promotes multi-lineage hematopoiesis. , 2012, Stem cell research.

[8]  L. Vidal,et al.  Hematopoietic growth factors in aplastic anemia patients treated with immunosuppressive therapy-systematic review and meta-analysis , 2009, Haematologica.

[9]  D. Kuter Thrombopoietin and thrombopoietin mimetics in the treatment of thrombocytopenia. , 2009, Annual review of medicine.

[10]  J. Luengo,et al.  Preclinical Activity of Eltrombopag (SB-497115), an Oral, Nonpeptide Thrombopoietin Receptor Agonist , 2009, Stem cells.

[11]  K. Kaushansky Historical review: megakaryopoiesis and thrombopoiesis. , 2008, Blood.

[12]  Lina A. Thoren,et al.  Critical role of thrombopoietin in maintaining adult quiescent hematopoietic stem cells. , 2007, Cell stem cell.

[13]  A. Roberts,et al.  Hematopoietic stem cell deficiencies in mice lacking c-Mpl, the receptor for thrombopoietin. , 1998, Proceedings of the National Academy of Sciences of the United States of America.

[14]  N. Young,et al.  Human thrombopoietin levels are high when thrombocytopenia is due to megakaryocyte deficiency and low when due to increased platelet destruction. , 1996, Blood.

[15]  W S Alexander,et al.  Deficiencies in progenitor cells of multiple hematopoietic lineages and defective megakaryocytopoiesis in mice lacking the thrombopoietic receptor c-Mpl. , 1996, Blood.

[16]  V. Broudy,et al.  Thrombopoietin expands erythroid, granulocyte-macrophage, and megakaryocytic progenitor cells in normal and myelosuppressed mice. , 1996, Experimental hematology.

[17]  R. Schreiber,et al.  In vitro megakaryocytopoietic and thrombopoietic activity of c-mpl ligand (TPO) on purified murine hematopoietic stem cells. , 1994, Blood.

[18]  K. Agarwal,et al.  Congenital amegakaryocytic thrombocytopenia. , 1968, Journal of the Indian Medical Association.