Publication details

Changes in bone marrow morphology in adults receiving romiplostim for the treatment of thrombocytopenia associated with primary immune thrombocytopenia

Authors

JANSSENS A. RODEGHIERO F. ANDERSON D. CHONG B.H. BODA Z. PABINGER I. ČERVINEK Libor TERRELL D.R. WANG X.N. FRANKLIN J.

Type Article in Periodical
Magazine / Source Annals of hematology
MU Faculty or unit

Faculty of Medicine

Citation
Doi http://dx.doi.org/10.1007/s00277-016-2682-2
Field Oncology and hematology
Keywords Immune thrombocytopenia (ITP); Thrombopoietin (TPO); Platelet; Bone marrow; Reticulin; Collagen
Description The effects of romiplostim on bone marrow morphology were evaluated in adults with immune thrombocytopenia (ITP). Patients with platelet counts < 50 x 10(9)/L, a parts per thousand yen1 prior ITP therapies, and no collagen at baseline received weekly subcutaneous romiplostim starting at 1 mu g/kg, adjusted to maintain platelet counts between 50 and 200 x 10(9)/L. Biopsies were scheduled after 1, 2, or 3 years of romiplostim (cohorts 1, 2, and 3, respectively). Irrespective of scheduled time, biopsies were performed earlier if patients discontinued or failed to achieve/maintain a response to romiplostim. Reticulin (silver stain) and collagen (trichrome stain) were graded by two hematopathologists using the modified Bauermeister scale (0-4). Of 169 patients, 131 had evaluable biopsies; 9/131 (6.9 %) had increases of a parts per thousand yen2 grades on the modified Bauermeister scale (cohort 1: 0/34; cohort 2: 2/39; cohort 3: 7/58), including two with collagen. Three of the nine patients had follow-up biopsies, including one patient with collagen; changes were reversible after romiplostim discontinuation. Of the nine patients, one had neutropenia detected by laboratory test and two had adverse events of anemia, both non-serious and not treatment-related. By actual exposure (as some biopsies did not occur as scheduled), the number of patients with grade increases a parts per thousand yen2 were year 1: 3/41, year 2: 1/38, year 3: 5/52. Twenty-four patients sustained platelet counts a parts per thousand yen50 x 10(9)/L for a parts per thousand yen6 months with no ITP medications after discontinuing romiplostim, i.e., they entered clinical remission of their ITP. In conclusion, in patients with ITP receiving romiplostim, bone marrow changes were observed in a small proportion of patients.