The role of thrombopoietin receptor agonists in reducing complications of chemotherapy-induced thrombocytopenia in patients with hematologic malignancies: review and single-center experience

Background. Chemotherapy-induced thrombocytopenia (CIT) is one of the most common and clinically significant complications of anticancer therapy. It limits the ability to maintain planned chemotherapy dose intensity, increases the risk of hemorrhagic complications, and leads to a higher demand for platelet transfusions. Given the limited efficacy and availability of transfusion support, the development of pharmacological approaches for CIT management is of high clinical relevance. Thrombopoietin receptor agonists, including avatrombopag, represent a promising strategy in supportive cancer care. Aim. To evaluate the efficacy and clinical relevance of prophylactic avatrombopag use in patients with chemotherapy-induced thrombocytopenia. Materials and methods. This observational study included 9 patients (4 males and 5 females) with oncological diseases who developed thrombocytopenia 100 × 109/L after a previous chemotherapy cycle. The median age was 52 years (range 27–68). Avatrombopag was administered prophylactically after completion of chemotherapy at a dose of 40 mg/day (20 mg twice daily) for 5 or 10 days, depending on the severity of thrombocytopenia. The following parameters were analyzed: nadir platelet count during the inter-cycle period, incidence of hemorrhagic events, requirement for platelet transfusions, and duration of delay of the subsequent chemotherapy cycle. Results. During avatrombopag administration, the median nadir platelet count remained unchanged at 10 × 109/L; however, a marked increase up to 79 × 109/L was observed in some patients. The incidence of hemorrhagic complications decreased from 55 to 11 %. The median number of platelet transfusions was reduced from 3 to 2 units. A significant reduction in chemotherapy delays was observed, with the median delay decreasing from 11 to 0 days. No avatrombopag-related adverse events were reported. Conclusion. Prophylactic use of avatrombopag in patients with chemotherapy-induced thrombocytopenia was associated with a reduced incidence of bleeding complications, decreased need for platelet transfusions, and fewer delays in subsequent chemotherapy cycles. Despite the limited sample size, these findings support the clinical value of avatrombopag as a supportive therapy and warrant further prospective studies.