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Romiplostim for the Management of Chemotherapy-Induced Thrombocytopenia

Chemotherapy-induced thrombocytopenia (CIT) can interfere with the optimal course of chemotherapy by necessitating schedule delays and dosage reductions. Some patients experience more severe or persistent thrombocytopenia than others, and their responses are neither well understood nor predictable. Both the prevention and management of CIT are critical in order for patients to benefit fully from chemotherapy.

Platelet transfusions have been the standard treatment for managing CIT, but recently romiplostim, a thrombopoietin receptor agonist, has been approved for treating thrombocytopenia in some patients. Romiplostim can stimulate platelet production similar to endogenous thrombopoietin. Studies of romiplostim for reducing thrombocytopenia, however, have been small, with different administration schedules, and they show mixed results. In a retrospective review of 20 patients, Dr. Parameswaran and colleagues recently reported on the successful use of weekly romiplostim for reducing CIT. Their review included both response to romiplostim therapy and toxicity assessment.

In this group of patients who had already demonstrated persistent thrombocytopenia, romiplostim improved platelet counts, allowing patients to resume chemotherapy. While a larger, prospective trial is needed to confirm the effectiveness of romiplostim, these results suggest that it may be a safe and effective treatment for CIT.

For more information, see Parameswaran R, Lunning M, Mantha S, Devlin S, Hamilton A, Schwartz G, and Soff G. Romiplostim for management of chemotherapy-induced thrombycytopenia. Support Care Cancer. 2014 May;22(5):1217-22.