How to increase thrombocytopenia (low platelet count) during chemotherapy (chemo) treatment?

From the Guidelines

To increase thrombocytopenia during chemotherapy treatment, prophylactic platelet transfusions are recommended for hospitalized adult patients with a platelet count of 10 × 10^9 cells/L or less to reduce the risk for spontaneous bleeding, as supported by the AABB guidelines 1.

Key Recommendations

• The AABB recommends transfusing hospitalized adult patients with a platelet count of 10 × 10^9 cells/L or less to reduce the risk for spontaneous bleeding 1.
• Prophylactic platelet transfusions have been found to significantly reduce the risk for spontaneous grade 2 or greater bleeding in patients with therapy-induced hypoproliferative thrombocytopenia 1.
• The threshold platelet count at which platelets should be transfused prophylactically to reduce the bleeding risk in hospitalized patients with therapy-induced hypoproliferative thrombocytopenia was examined in 4 RCTs, and the results support the recommendation of transfusing at a platelet count of 10 × 10^9 cells/L or less 1.

Additional Considerations

• Medications like Oprelvekin (Interleukin-11) or Romiplostim (Nplate) may be considered to stimulate platelet production, but the evidence for their use is not as strong as for prophylactic platelet transfusions 1.
• Dietary changes, such as eating foods rich in folate, vitamin B12, iron, and vitamin K, may help support platelet production, but their effectiveness is not well established 1.
• Minimizing activities with bleeding risk and avoiding alcohol, which can suppress platelet production, are also important considerations for patients with thrombocytopenia during chemotherapy treatment 1.

From the FDA Drug Label

In clinical trials, platelet counts generally increased within 1 to 2 weeks after starting ALVAIZ and decreased within 1 to 2 weeks after discontinuing ALVAIZ The median time to achieve the target platelet count greater than or equal to 90 x 109/L was approximately 2 weeks Use the lowest dose of ALVAIZ to achieve and maintain a platelet count necessary to initiate and maintain antiviral therapy with pegylated interferon and ribavirin Adjust the dose of ALVAIZ in 18-mg increments every 2 weeks as necessary to achieve the target platelet count required to initiate antiviral therapy

To increase thrombocytopenia (low platelet count) during chemotherapy treatment, eltrombopag (ALVAIZ) can be used. The recommended dosage is to use the lowest dose to achieve and maintain a platelet count necessary to initiate and maintain antiviral therapy.

• Initial dose: 18 mg orally once daily for chronic hepatitis C-associated thrombocytopenia
• Dose adjustment: Adjust the dose in 18-mg increments every 2 weeks as necessary to achieve the target platelet count
• Monitoring: Monitor platelet counts every week prior to starting antiviral therapy and monthly thereafter
• Maximum dose: Do not exceed a dose of 72 mg daily 2

From the Research

Treatment Options for Chemotherapy-Induced Thrombocytopenia

• Thrombopoietin receptor agonists (TPO-RAs) have been studied as a potential treatment for chemotherapy-induced thrombocytopenia (CIT) in patients with solid tumors 3.
• The use of TPO-RAs may make little or no difference to the all-cause mortality at 33 weeks of follow-up, and there is not enough evidence to determine whether TPO-RAs reduce the number of patients with at least one bleeding episode of any severity or at least one severe/life-threatening bleeding episode 3.
• National Comprehensive Cancer Network guidelines recommend consideration of TPO-RA clinical trials as well as off-label use of romiplostim for the management of CIT 4.
• Thrombopoietic growth factors, such as recombinant human thrombopoietin, pegylated human megakaryocyte growth and development factor, romiplostim, eltrombopag, avatrombopag, and hetrombopag, improve pretreatment and nadir platelet counts, reduce the need for platelet transfusions, and enable chemotherapy dose intensity to be maintained 5.

Mechanisms and Potential Therapies

• Chemotherapy significantly affects various cells in the bone marrow microenvironment, reducing their ability to support normal hematopoiesis and leading to bone marrow damage, including CIT in cancer patients 6.
• Thrombopoietin (TPO) replacement therapy has been invented and used to treat CIT, but this treatment is limited by the risk of immunogenicity and cancer progression 6.
• Anti-MPL antibodies, such as 2R13, have been identified as potential therapeutic agents for CIT treatment, stimulating megakaryocyte differentiation and increasing platelet production 7.

Ongoing Research and Future Directions

• Further research is needed to fully understand the mechanisms of CIT and to develop effective therapies for its treatment 6, 5.
• Ongoing studies are investigating the use of TPO-RAs and other thrombopoietic growth factors for the prevention and treatment of CIT in patients with solid tumors 3, 5.
• The development of new therapeutic agents, such as anti-MPL antibodies, may provide promising treatment options for CIT in the future 7.