Successful treatment of secondary poor graft function post allogeneic hematopoietic stem cell transplantation with eltrombopag
Abstract Poor graft function (PGF) is a life-threatening complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Current treatment strategies include the use of growth factors, CD34+-selected stem cell boost, mesenchymal stem cell transfusion, and second allo-HSCT, but the...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2018-08-01
|
| Series: | Journal of Hematology & Oncology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13045-018-0649-6 |
| _version_ | 1819113376405520384 |
|---|---|
| author | Cen Tang Feng Chen Danqing Kong Qinfen Ma Haiping Dai Jia Yin Zheng Li Jia Chen Xiaming Zhu Xinliang Mao Depei Wu Xiaowen Tang |
| author_facet | Cen Tang Feng Chen Danqing Kong Qinfen Ma Haiping Dai Jia Yin Zheng Li Jia Chen Xiaming Zhu Xinliang Mao Depei Wu Xiaowen Tang |
| author_sort | Cen Tang |
| collection | DOAJ |
| description | Abstract Poor graft function (PGF) is a life-threatening complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Current treatment strategies include the use of growth factors, CD34+-selected stem cell boost, mesenchymal stem cell transfusion, and second allo-HSCT, but these treatments are not effective in all patients. Eltrombopag, an oral thrombopoietin receptor agonist, which showed promising results in severe aplasia anemia, may be an alternative choice for PGF patients. Therefore, we treated 12 patients who responded poorly to standard treatments for secondary PGF after allo-HSCT with eltrombopag. The median duration was 116 (35–1000) days from transplantation to PGF diagnosis and 59 (30–180) days from PGF diagnosis to eltrombopag treatment. Eltrombopag was started at a dose of 25 mg/d for 3 days and then increased to 50 or 75 mg/d. Median treatment duration was 8 (2–23) weeks. Ten patients (83.3%) responded to the treatment: 8 achieved complete response (CR), and the remaining 2 achieved partial response. In the 10 responding subjects, median platelet count was 18 (5–27) × 109/L vs 74 (30–117) × 109/L prior to and after treatment. Neutrophil count was 0.51 (0.28–0.69) × 109/L vs 1.84 (0.78–4.90) × 109/L. Hemoglobin was 88 (63–123) vs 101 (78–134) g/L. In the 8 patients who achieved CR, the time from eltrombopag initiation to achieving CR was 29 (10–49) days; the response lasted until the last follow-up in all 8 CR subjects (10–18 months). The 12-month overall survival rate was 83.3%. There was no treatment-related mortality and no evidence of cataract, thrombosis, or any other grade 3/4 toxicities. |
| first_indexed | 2024-12-22T04:28:25Z |
| format | Article |
| id | doaj.art-b9c15123f5344b3588d7ee307d85c0c2 |
| institution | Directory Open Access Journal |
| issn | 1756-8722 |
| language | English |
| last_indexed | 2024-12-22T04:28:25Z |
| publishDate | 2018-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Hematology & Oncology |
| spelling | doaj.art-b9c15123f5344b3588d7ee307d85c0c22022-12-21T18:39:05ZengBMCJournal of Hematology & Oncology1756-87222018-08-011111410.1186/s13045-018-0649-6Successful treatment of secondary poor graft function post allogeneic hematopoietic stem cell transplantation with eltrombopagCen Tang0Feng Chen1Danqing Kong2Qinfen Ma3Haiping Dai4Jia Yin5Zheng Li6Jia Chen7Xiaming Zhu8Xinliang Mao9Depei Wu10Xiaowen Tang11Department of Hematology, The First Affiliated Hospital of Soochow University, Jiangsu Institute of HematologyDepartment of Hematology, The First Affiliated Hospital of Soochow University, Jiangsu Institute of HematologyDepartment of Hematology, The First Affiliated Hospital of Soochow University, Jiangsu Institute of HematologyDepartment of Hematology, The First Affiliated Hospital of Soochow University, Jiangsu Institute of HematologyDepartment of Hematology, The First Affiliated Hospital of Soochow University, Jiangsu Institute of HematologyDepartment of Hematology, The First Affiliated Hospital of Soochow University, Jiangsu Institute of HematologyDepartment of Hematology, The First Affiliated Hospital of Soochow University, Jiangsu Institute of HematologyDepartment of Hematology, The First Affiliated Hospital of Soochow University, Jiangsu Institute of HematologyDepartment of Hematology, The First Affiliated Hospital of Soochow University, Jiangsu Institute of HematologyDepartment of Pharmacology, College of Pharmaceutical Sciences, Soochow UniversityDepartment of Hematology, The First Affiliated Hospital of Soochow University, Jiangsu Institute of HematologyDepartment of Hematology, The First Affiliated Hospital of Soochow University, Jiangsu Institute of HematologyAbstract Poor graft function (PGF) is a life-threatening complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Current treatment strategies include the use of growth factors, CD34+-selected stem cell boost, mesenchymal stem cell transfusion, and second allo-HSCT, but these treatments are not effective in all patients. Eltrombopag, an oral thrombopoietin receptor agonist, which showed promising results in severe aplasia anemia, may be an alternative choice for PGF patients. Therefore, we treated 12 patients who responded poorly to standard treatments for secondary PGF after allo-HSCT with eltrombopag. The median duration was 116 (35–1000) days from transplantation to PGF diagnosis and 59 (30–180) days from PGF diagnosis to eltrombopag treatment. Eltrombopag was started at a dose of 25 mg/d for 3 days and then increased to 50 or 75 mg/d. Median treatment duration was 8 (2–23) weeks. Ten patients (83.3%) responded to the treatment: 8 achieved complete response (CR), and the remaining 2 achieved partial response. In the 10 responding subjects, median platelet count was 18 (5–27) × 109/L vs 74 (30–117) × 109/L prior to and after treatment. Neutrophil count was 0.51 (0.28–0.69) × 109/L vs 1.84 (0.78–4.90) × 109/L. Hemoglobin was 88 (63–123) vs 101 (78–134) g/L. In the 8 patients who achieved CR, the time from eltrombopag initiation to achieving CR was 29 (10–49) days; the response lasted until the last follow-up in all 8 CR subjects (10–18 months). The 12-month overall survival rate was 83.3%. There was no treatment-related mortality and no evidence of cataract, thrombosis, or any other grade 3/4 toxicities.http://link.springer.com/article/10.1186/s13045-018-0649-6EltrombopagSecondary poor graft functionAllogeneic hematopoietic stem cell transplantation |
| spellingShingle | Cen Tang Feng Chen Danqing Kong Qinfen Ma Haiping Dai Jia Yin Zheng Li Jia Chen Xiaming Zhu Xinliang Mao Depei Wu Xiaowen Tang Successful treatment of secondary poor graft function post allogeneic hematopoietic stem cell transplantation with eltrombopag Journal of Hematology & Oncology Eltrombopag Secondary poor graft function Allogeneic hematopoietic stem cell transplantation |
| title | Successful treatment of secondary poor graft function post allogeneic hematopoietic stem cell transplantation with eltrombopag |
| title_full | Successful treatment of secondary poor graft function post allogeneic hematopoietic stem cell transplantation with eltrombopag |
| title_fullStr | Successful treatment of secondary poor graft function post allogeneic hematopoietic stem cell transplantation with eltrombopag |
| title_full_unstemmed | Successful treatment of secondary poor graft function post allogeneic hematopoietic stem cell transplantation with eltrombopag |
| title_short | Successful treatment of secondary poor graft function post allogeneic hematopoietic stem cell transplantation with eltrombopag |
| title_sort | successful treatment of secondary poor graft function post allogeneic hematopoietic stem cell transplantation with eltrombopag |
| topic | Eltrombopag Secondary poor graft function Allogeneic hematopoietic stem cell transplantation |
| url | http://link.springer.com/article/10.1186/s13045-018-0649-6 |
| work_keys_str_mv | AT centang successfultreatmentofsecondarypoorgraftfunctionpostallogeneichematopoieticstemcelltransplantationwitheltrombopag AT fengchen successfultreatmentofsecondarypoorgraftfunctionpostallogeneichematopoieticstemcelltransplantationwitheltrombopag AT danqingkong successfultreatmentofsecondarypoorgraftfunctionpostallogeneichematopoieticstemcelltransplantationwitheltrombopag AT qinfenma successfultreatmentofsecondarypoorgraftfunctionpostallogeneichematopoieticstemcelltransplantationwitheltrombopag AT haipingdai successfultreatmentofsecondarypoorgraftfunctionpostallogeneichematopoieticstemcelltransplantationwitheltrombopag AT jiayin successfultreatmentofsecondarypoorgraftfunctionpostallogeneichematopoieticstemcelltransplantationwitheltrombopag AT zhengli successfultreatmentofsecondarypoorgraftfunctionpostallogeneichematopoieticstemcelltransplantationwitheltrombopag AT jiachen successfultreatmentofsecondarypoorgraftfunctionpostallogeneichematopoieticstemcelltransplantationwitheltrombopag AT xiamingzhu successfultreatmentofsecondarypoorgraftfunctionpostallogeneichematopoieticstemcelltransplantationwitheltrombopag AT xinliangmao successfultreatmentofsecondarypoorgraftfunctionpostallogeneichematopoieticstemcelltransplantationwitheltrombopag AT depeiwu successfultreatmentofsecondarypoorgraftfunctionpostallogeneichematopoieticstemcelltransplantationwitheltrombopag AT xiaowentang successfultreatmentofsecondarypoorgraftfunctionpostallogeneichematopoieticstemcelltransplantationwitheltrombopag |