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Int J Angiol
DOI: 10.1055/s-0041-1726366
Rapid Communication

Sequential Use of Romiplostim after Eltrombopag for Refractory Thrombocytopenia in Hydrocarbon-Induced Myelodysplasia

Luis F. Morales‡   *
1   Department of Surgery, North Shore University Hospital, Manhasset, New York
,
Santiago J. Miyara  ‡   *
2   Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
3   Feinstein Institutes for Medical Research, Manhasset, New York
,
Sara Guevara‡   *
1   Department of Surgery, North Shore University Hospital, Manhasset, New York
,
Christine N. Metz
2   Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
3   Feinstein Institutes for Medical Research, Manhasset, New York
,
Muhammad Shoaib
3   Feinstein Institutes for Medical Research, Manhasset, New York
4   Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
5   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
,
Stacey Watt
6   Jacobs School of Medicine and Biomedical Sciences, Buffalo, University at Buffalo, Buffalo, New York
,
Stefanos Zafeiropoulos
2   Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
3   Feinstein Institutes for Medical Research, Manhasset, New York
,
Alexia McCann-Molmenti
1   Department of Surgery, North Shore University Hospital, Manhasset, New York
,
Kei Hayashida
3   Feinstein Institutes for Medical Research, Manhasset, New York
4   Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
,
Ryosuke Takegawa
3   Feinstein Institutes for Medical Research, Manhasset, New York
4   Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
,
Koichiro Shinozaki
3   Feinstein Institutes for Medical Research, Manhasset, New York
4   Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
,
Rishabh C. Choudhary
3   Feinstein Institutes for Medical Research, Manhasset, New York
4   Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
,
Elena C. Brindley
3   Feinstein Institutes for Medical Research, Manhasset, New York
5   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
,
Mitsuaki Nishikimi
3   Feinstein Institutes for Medical Research, Manhasset, New York
4   Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
,
Adam M. Kressel
1   Department of Surgery, North Shore University Hospital, Manhasset, New York
3   Feinstein Institutes for Medical Research, Manhasset, New York
,
Yaser M. Alsalmay
1   Department of Surgery, North Shore University Hospital, Manhasset, New York
,
Elvio A. Mazzotta
7   Department of Anesthesiology, The Wexner Medical Center, The Ohio State University, Columbus, Ohio
,
Young Min Cho
1   Department of Surgery, North Shore University Hospital, Manhasset, New York
3   Feinstein Institutes for Medical Research, Manhasset, New York
,
Gabriel I. Aranalde
1   Department of Surgery, North Shore University Hospital, Manhasset, New York
,
Daniel A. Grande
2   Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
3   Feinstein Institutes for Medical Research, Manhasset, New York
5   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
,
Stavros Zanos
2   Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
3   Feinstein Institutes for Medical Research, Manhasset, New York
,
Lance B. Becker
1   Department of Surgery, North Shore University Hospital, Manhasset, New York
2   Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
3   Feinstein Institutes for Medical Research, Manhasset, New York
5   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
,
Ernesto P. Molmenti
1   Department of Surgery, North Shore University Hospital, Manhasset, New York
3   Feinstein Institutes for Medical Research, Manhasset, New York
4   Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
5   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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Abstract

We describe the clinical course of a 65-year-old male patient who suffered from hydrocarbon-induced myelodysplasia and was successfully treated with the thrombopoietin receptor agonist (TPO-RA), romiplostim. Myelodysplastic syndromes (MDS) are characterized by ineffective hematopoiesis, cytopenias, and increased risk of leukemic transformation. Here, we present a clinical vignette of MDS-associated thrombocytopenia refractory to first-line drugs as well as the TPO-RA, eltrombopag. To date, romiplostim is an U.S. Food and Drug Administration (FDA)-approved drug for idiopathic thrombocytopenic purpura and thrombocytopenia secondary to liver disease. Of note, currently the FDA advises against its use in MDS based on previous long-term safety concerns. Since the therapeutic options for thrombocytopenia in MDS patients are sparse, repurposing and reassessing romiplostim in this setting have been the focus of recent studies. At the time of writing, no published double-blind randomized clinical trials have conducted a head-to-head comparison between romiplostim and eltrombopag in thrombocytopenic MDS patients. To the best of our knowledge, for a thrombocytopenic patient in the setting of MDS, this is the first documented report of refractory clinical response after a 2-year use of eltrombopag in which replacement of treatment with romiplostim resulted in sustained physiological counts of thrombocytes within four weeks.

Keywords

romiplostim - myelodysplastic syndromes - thrombopoietin receptor agonist - thrombopoiesis - thrombocytopenia - eltrombopag

* These authors had equal contribution.




Publication History

Received: 27 August 2020

Accepted: 19 January 2021

Article published online:
03 September 2021

© 2021. International College of Angiology. This article is published by Thieme.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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