Romiplostim resistance in secondary failure of platelet recovery

Romiplostim, a thrombopoietin mimetic, is FDA approved for the treatment of thrombocytopenia in patients with refractory immune thrombocytopenia. Given the success of thrombopoietin agonists in the treatment of immune thrombocytopenia, data in other clinical settings are emerging. In the bone marrow...

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Bibliographic Details
Published in:Journal of oncology pharmacy practice 2013-12, Vol.19 (4), p.369-372
Main Authors: DeRemer, David L, Katsanevas, Katerina, Bradley, Amber, Awan, Farrukh T
Format: Article
Language:English
Subjects:
Blood platelets
Dose-Response Relationship, Drug
Drug Resistance
Drug therapy
Humans
Leukemia
Leukemia, Lymphocytic, Chronic, B-Cell - therapy
Male
Middle Aged
Platelet Count
Receptors, Fc - therapeutic use
Recombinant Fusion Proteins - therapeutic use
Stem Cell Transplantation - methods
Stem cells
Thrombocytopenia - drug therapy
Thrombocytopenia - etiology
Thrombopoietin - therapeutic use
Transplants & implants
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Summary:Romiplostim, a thrombopoietin mimetic, is FDA approved for the treatment of thrombocytopenia in patients with refractory immune thrombocytopenia. Given the success of thrombopoietin agonists in the treatment of immune thrombocytopenia, data in other clinical settings are emerging. In the bone marrow transplant setting, secondary failure of platelet recovery and persistent thrombocytopenia are associated with increased mortality. In this case, romiplostim was attempted in a chronic lymphocytic leukemia patient who underwent a matched, unrelated donor, non-myeloablative stem cell transplant. This patient experienced profound thrombocytopenia despite dose escalation. Anti-thrombopoietin or anti-romiplostim antibodies were not detected by specific assays. Furthermore, the patient remains in disease remission with full chimerism. This case demonstrates that heavily pre-treated patients with limited bone marrow reserve may not respond to thrombopoietin agonists.
ISSN:1078-1552
1477-092X
DOI:10.1177/1078155212469640