Abstract

Title: Lusutrombopag Improves Platelet Engraftment after Autologous Haematopoietic Stem Cell Transplantation in Multiple Myeloma: A Single-Centre Retrospective Study

Background

Multiple myeloma (MM) is the second most common haematological malignancy globally, with >170,000 annual cases. Over 90% of eligible patients require autologous haematopoietic stem cell transplantation (ASCT) as standard therapy. Delayed platelet engraftment remains a frequent post-transplant complication, increasing haemorrhagic risk and potentially contributing to mortality. This delay may lead to platelet transfusion dependence/refractoriness, heightened transfusion reactions, prolonged hospitalisation, increased healthcare costs, and reduced quality of life. Currently, no pharmacologic interventions are approved, with reliance solely on platelet transfusions (response rate <60%), underscoring the need for safe, proactive strategies.

Objective

This study aimed to evaluate the effect of lusutrombopag on platelet engraftment time post-ASCT in MM patients, providing evidence-based support for optimised transplantation management.

Methods

This single-centre retrospective study enrolled 24 MM patients treated at China-Japan Union Hospital of Jilin University between 1 December 2024 and 1 August 2025. Patients were stratified into two cohorts:

Lusutrombopag group (n=9): Received oral lusutrombopag 3mg/day (with meals) initiated when post-infusion platelet count first fell ≤50×10⁹/L, continued until engraftment (defined as platelet count ≥20×10⁹/L without transfusion for 7 consecutive days).

Control group (n=15): Historical controls receiving standard care without lusutrombopag.

Primary outcome: Time to platelet engraftment.

Result

Lusutrombopag accelerated platelet engraftment:

Median engraftment time: 10 days (lusutrombopag) vs 12 days (controls)

Cumulative incidence at day +13: Significantly higher in lusutrombopag group (P*=0.002; 95% CI: -3.5 to -1.0 days)

≤10-day engraftment rate: Significantly increased (OR=12.5; P*=0.006)

Both groups exhibited favourable outcomes with no adverse events.

Conclusion

Lusutrombopag accelerates platelet engraftment post-ASCT in MM patients, reducing median time by 2 days and transfusion requirements, thereby optimising this critical treatment phase.

Keywords: Lusutrombopag; Multiple myeloma; Autologous haematopoietic stem cell transplantation; Platelet engraftment; Retrospective study

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2025
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