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Low Platelet Therapy for Myeloma
One of the most frequently asked questions in online MM groups is about low blood counts, aka myelosuppression. The study below cites low platelet therapy for myeloma or chemotherapy-induced thrombocytopenia.
Symptoms of low platelets could be increased bleeding or increased bruising.
If a myeloma patient undergoing therapy is diagnosed with Chemotherapy-induced thrombocytopenia, they may have to discontinue therapy for a time, disrupting their treatment plan.
Chemotherapy-induced thrombocytopenia: shifting treatment strategies and the use of TPOR agonists
I am a long-term MM survivor. While I write about possible therapies for common MM problems like myelosuppression, I have to also point out possible side effects- please see the list of possible side effects below.
Email me at David.PeopleBeatingCancer@gmail.com with questions about managing your MM.
Thank you,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
“Chemotherapy-induced thrombocytopenia (CIT) is a common side effect of cancer treatment where chemotherapy drugs negatively impact platelet production, leading to a low platelet count.”
Romiplostim, also known by the brand name Nplate®, is a prescription medicine used to treat low blood platelet counts.
Novel Therapeutic Approaches Exhibit Promising Efficacy for Chemotherapy-Induced Thrombocytopenia
- Data from two studies demonstrate the efficacy of romiplostim and Carica papaya leaf extract (CPLE) for the treatment of chemotherapy-induced thrombocytopenia (CIT), for which there are currently no U.S. Food and Drug Administration (FDA)–approved therapies.
- A phase 3 trial of patients receiving oxaliplatin-based multiagent regimens for colorectal, gastroesophageal, or pancreatic cancers found that 84.4% of patients in the romiplostim arm did not have a chemotherapy dose modification due to CIT versus 35.7% in the placebo arm.
- A separate phase 3 trial, analyzing CPLE in patients with solid tumors receiving chemotherapy and grade 2/3 CIT, found that CPLE was significantly more effective in improving platelet counts on day 4 compared with placebo (64% vs 48%)
According to Dr. Al-Samkari, oncologists typically encounter patients with CIT multiple times per day in their practice; however, unlike for neutropenia or anemia, there are no available, effective FDA-approved therapies for CIT. “Platelet transfusions are very scarce, not available in certain locations and only last a few days, in contrast to blood transfusions for anemia and [granulocyte colony-stimulating factor] for neutropenia,” he said…
This phase 3 trial randomly assigned a total of 109 patients to receive romiplostim and 56 to receive placebo. The study’s primary endpoint was a restoration of platelet counts such that patients did not require a CIT-induced dose modification of any myelosuppressive agent in either the second or third chemotherapy cycles…
Study findings revealed that 84.4% of patients in the romiplostim arm met the primary endpoint and did not have a chemotherapy dose modification due to CIT, as compared with only 35.7% of patients in the placebo arm…
Common Side Effects:
- Headache
- Joint and muscle pain
- Dizziness
- Trouble sleeping (insomnia)
- Pain in arms, legs, or shoulder
- Stomach pain or indigestion
- Numbness, tingling, or burning in hands or feet
- Upper respiratory tract infection
- Cough
- Nausea or vomiting
- Diarrhea
- Sore throat or pain in the mouth/throat
- Bruising (more common in children 1 year and older)
Serious Side Effects:
- Blood Clots: Romiplostim can increase the risk of blood clots, especially if platelet counts become too high. These clots can lead to serious complications like stroke, heart attack, or pulmonary embolism.
- Bone Marrow Problems: There’s a risk of developing new or worsening changes in the bone marrow, such as increased reticulin, which could affect blood cell production. Your doctor may monitor your bone marrow for this.
- Worsening of Myelodysplastic Syndromes (MDS): Romiplostim is not for use in individuals with MDS, as it can worsen the condition and increase the risk of developing acute leukemia.
- Severe Allergic Reactions: While rare, serious allergic reactions like breathing problems, swelling, hives, or dizziness can occur. Seek immediate medical attention if you experience these symptoms.
- Bleeding: While Romiplostim aims to reduce bleeding risk, it’s still possible to experience bleeding or bruising. Your doctor will monitor your platelet levels to manage this risk.
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