Comparison of thrombopoietin receptor agonists plus recombinant human thrombopoietin vs. recombinant human thrombopoietin alone for hematopoietic reconstruction in multiple myeloma patients undergoing autologous hematopoietic stem cell transplantation

Fangxia Wang; Xuezhu Xu; Ruoyu Yang; Yachun Jia; Gongzhizi Gao; Tianyu Huang; Aili He

doi:10.1016/j.jtct.2024.12.015

Comparison of thrombopoietin receptor agonists plus recombinant human thrombopoietin vs. recombinant human thrombopoietin alone for hematopoietic reconstruction in multiple myeloma patients undergoing autologous hematopoietic stem cell transplantation

Transplant Cell Ther. 2024 Dec 21:S2666-6367(24)00834-0. doi: 10.1016/j.jtct.2024.12.015. Online ahead of print.

Authors

Fangxia Wang¹, Xuezhu Xu², Ruoyu Yang², Yachun Jia², Gongzhizi Gao², Tianyu Huang², Aili He²

Affiliations

¹ Xi'an Jiaotong University Second Affiliated Hospital, China. Electronic address: wfx197478@163.com.
² Xi'an Jiaotong University Second Affiliated Hospital, China.

PMID: 39716625
DOI: 10.1016/j.jtct.2024.12.015

Abstract

Background: Hetrombopag is a novel thrombopoietin receptor agonist that has shown an additive effect in stimulating platelet production when combined with recombinant human thrombopoietin (rhTPO). But it remains unclear whether this combination can promote hematopoietic reconstruction after autologous stem cell transplant (ASCT).

Purpose: To compare the effect of recombinant human thrombopoietin (rhTPO) plus thrombopoietin receptor agonists (TPO-RA) versus rhTPO alone on hematopoietic recovery, adverse events, post-operative complications, and cost effectiveness in patients with newly diagnosed multiple myeloma (NDMM) undergoing autologous stem cell transplant (ASCT).

Methods: Sixty-seven NDMM consecutive patients who underwent ASCT at our hospital from January 2021 to May 2024 were included. Thirty-five patients received a combination of rhTPO and the TPO-RA hetrombopag after stem cell reinfusion (observation group), while 32 patients received rhTPO alone (control group). Hematopoietic reconstitution between the two groups was compared.

Results: Baseline clinical characteristics were similar between both groups. In the observation group, the median time to platelet recovery was the 9 days after stem cell reinfusion, which significantly shorter than that in the control group (p=0.003). The mean number of platelet transfusion in the observation group was significantly lower than that in the control group (1.0 vs 2.0 units, p=0.034). All the patients tolerated rhTPO and TPO-RA well, with no thrombotic events observed. Survival analysis showed no reduction in time to progression (TTP) and overall survival (OS) with the addition of TPO-RA. There were no statistical differences in the incidence of adverse events, drug expenses and hospital stay between two groups (p > 0.05).

Conclusions: Although sample size and study design limit the data from this study, our findings suggest the combination of TPO-RA (hetrombopag) with rhTPO enhance platelet recovery in comparison to rhTPO alone, without increasing adverse effects.

Keywords: autologous hematopoietic stem cell transplantation; hematopoietic reconstruction; multiple myeloma; recombinant human thrombopoietin; thrombopoietin receptor agonists.