Recombinant Human Thrombopoietin Combined with Thrombopoietin Receptor Agonists Can Facilitate the Recovery of Platelet after Autologous Hematopoietic Stem Cell Transplantation for Multiple Myeloma

Abstract

Background

Autologous hematopoietic stem cell transplantation (ASCT) has been widely used in the treatment of hematologic tumors and has achieved significant efficacy, especially for multiple myeloma (MM). The high-dose conditioning regimen of ASCT always causes myelosuppression which might lead to neutropenia and thrombocytopenia. In clinical practice, thrombopoietin receptor agonists (TPO-RAs) and recombinant human thrombopoietin (rh-TPO) have been applied to refractory thrombocytopenia after ASCT and has shown a certain efficacy, respectively. But very few clinical data are available regarding the use of TPO-RAs combined with rh-TPO after ASCT for NDMM patients.

Aims

To compare the effect of rh-TPO plus TPO-RA (hetrombopag) on white blood cell and platelet (PLT) recovery, adverse events, post-operative complications, and cost effectiveness after autologous stem cell transplant (ASCT) in patients with newly diagnosed multiple myeloma (NDMM).

Methods

Ninety-five cases with NDMM had been enrolled from January 2018 to December 2023. The hematopoietic reconstitution was compared between these 35 cases receiving rh-TPO combined with TPO-RA after stem cell reinfusion as observation group and 60 cases only receiving rh-TPO classified as the control group.

Results

There were no significant differences in the baseline clinical characteristics between two groups. In the observation group, the median time to platelet was the 10^th day after stem cell reinfusion, which were significantly shorter than those of the control group (P＜0.001). The mean units of platelet transfusion in the observation group were significantly lower than those in the control group (1.0 vs 1.5 units, P=0.007). All the patients tolerated rh-TPO and TPO-RA well and no thrombotic events occurred. Survival analysis showed no decrease in time to progression (TTP) or overall survival (OS) by TPO-RA administration. There were no statistical differences in the incidence of adverse events, total expense and hospital stay between two groups (P > 0.05).

Conclusions

Our data shows that the treatment protocol of TPO-RA (hetrombopag) combined with rh-TPO may boost a faster platelet growth rate. Importantly, no additional adverse effects occurred when the addition of TPO-RA.

No relevant conflicts of interest to declare.