Recombinant Human Thrombopoietin Attenuates Carboplatin-Induced Severe Thrombocytopenia and the Need for Platelet Transfusions in Patients with Gynecologic Cancer

Background: Thrombocytopenia is a significant problem in the treatment of cancer. Objective: To assess the clinical safety of therapy with recombinant human thrombopoietin (rhTPO) and its ability to ameliorate chemotherapy-induced severe thrombocytopenia. Design: Phase I/II clinical cohort study. Setting: The University of Texas M.D. Anderson Cancer Center, Houston, Texas. Patients: 29 patients with gynecologic cancer. Intervention: Recombinant human thrombopoietin was given before chemotherapy and after a second cycle of carboplatin therapy. Measurements: Peripheral blood counts and platelet transfusions. Results: Administration of rhTPO after chemotherapy significantly reduced the degree and duration of thrombocytopenia and enhanced platelet recovery. In patients who received the optimal biological dose of rhTPO (1.2 µg/kg of body weight) in cycle 2 (carboplatin plus rhTPO), the mean platelet count nadir was higher (44 × 109 cells/L and 20 × 109 cells/L; P = 0.002) and the duration of thrombocytopenia was shorter (days with a platelet count <20 × 109 cells/L, 1 and 4 [P = 0.002]; days with a platelet count <50 × 109 cells/L, 4 and 7 [P = 0.006]) than in cycle 1 (carboplatin only). The need for platelet transfusion in this group was reduced from 75% of patients in cycle 1 to 25% of patients in cycle 2 (P = 0.013). Conclusions: Therapy with rhTPO seems to be safe and may attenuate chemotherapy-induced severe thrombocytopenia and reduce the need for platelet transfusions.