Management of Chemotherapy Induced Thrombocytopenia
Use of Platelet Transfusion for Severe CIT
Thrombocytopenia Receptor Agonists for CIT in Solid Tumors
- If considering use of a TPO-RA, we suggest enrollment in a clinical trial as preference.
- If unable to enroll in a clinical trial, we suggest consideration of a TPO-RA in the setting of inadequate platelet recovery at day 1 of a chemotherapy cycle to avoid chemotherapy dose reduction or a delay of 7 or more days. (Assuming adequate neutrophil and hemoglobin recovery.)
- Potential use of a TPO-RA should be in patients with solid tumors where full dose chemotherapy is expected to achieve or maintain a clinically-relevant response. (Note, the use of TPO-RA has not been studied in an adjuvant setting.)
- Goals of therapy for use of a TPO-RA should be to achieve an adequate platelet count to avoid reduced chemotherapy dose intensity in future cycles.
- Once initiated, a TPO-RA should be continued for the duration of chemotherapy, with titration to the lowest dose to maintain a target platelet count between 100-200 x 109/L (or titrate to the platelet count to allow full relative dose intensity chemotherapy) at the beginning of each chemotherapy cycle.
- When considering off-label use of TPO-RA (not in the setting of a clinical trial), we recommend use of romiplostim over other TPO-RAs.
- We recommend against the initiation of TPO-RA during chemotherapy nadir of index episode as there are no data to indicate shortening of the depth or duration of an acute nadir, and there are no data on safety in this setting.
Thrombopoietin Receptor Agonists for in Acute Myeloid Leukemia or High-Risk Myelodysplasia
Thrombopoietin Receptor Agonists in Lymphoma
Tranexamic Acid for Chemotherapy Induced Thrombocytopenia
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Overview
Title
Management of Chemotherapy Induced Thrombocytopenia
Authoring Organization
International Society on Thrombosis and Haemostasis
Publication Month/Year
October 9, 2023
Last Updated Month/Year
April 1, 2024
Document Type
Guideline
Country of Publication
Global
Document Objectives
Thrombocytopenia is a common adverse effect of chemotherapy. The development of chemotherapy induced thrombocytopenia (CIT) is influenced by cancer type and therapy, occurring in approximately one-third of patients with a solid tumor diagnosis and half of all patients with a hematologic malignancy. CIT may complicate the administration of chemotherapy leading to therapeutic delays or dose reductions. This guidance document, presented by the ISTH Subcommittee on Hemostasis and Malignancy, provides a comprehensive summary of the evidence and offers direction on the use of thrombopoietin receptor agonists (TPO-RAs) in various settings of CIT, including solid tumors, acute myeloid leukemia, stem cell transplant, and lymphoma. Studies have shown that TPO-RAs can improve platelet counts in CIT, but the clinical benefits of TPO-RA in terms of reducing bleeding, limiting platelet transfusion, or avoiding chemotherapy delay or dose reduction are uncertain. Further research is needed to optimize the selection of appropriate indications and study design to manage thrombocytopenia following chemotherapy.
Inclusion Criteria
Male, Female, Adult, Infant
Health Care Settings
Ambulatory, Hospital, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Management
Diseases/Conditions (MeSH)
D013921 - Thrombocytopenia
Keywords
chemotherapy, thrombocytopenia, Chemotherapy Induced Thrombocytopenia, thrombopoietin
Source Citation
Gerald Soff, Avi Leader, Hanny Al-Samkari, Anna Falanga, Anthony Maraveyas, Kristen Sanfilippo, Tzu-Fei Wang, Jeffrey Zwicker, Management of Chemotherapy Induced thrombocytopenia: Guidance from the ISTH Subcommittee on Hemostasis & Malignancy, Journal of Thrombosis and Haemostasis, 2023, ISSN 1538-7836, https://doi.org/10.1016/j.jtha.2023.09.031