| BackgroundWith the continuous development of the treatment of malignant lymphoma,chemotherapy plays an important role in the treatment of patients with malignant lymphoma,and chemotherapy induced thrombocytopenia(CIT)is one of the common complications of chemotherapy in patients with malignant lymphoma.It can cause skin and mucous membrane hemorrhage,and in severe cases,it can lead to visceral and craniocerebral hemorrhage,which is life-threatening;in addition,continuous CIT may delay the treatment of the primary disease.At present,there are few treatments for malignant lymphoma CIT,mainly including platelet transfusion,recombinant human interleukin-11(rhIL-11)and recombinant human thrombopoietin(rhTPO).Platelet transfusion will cause transfusion-related complications and the risk of infectious disease infection;rhIL-11 limits its use due to significant side effects;rhTPO,as an injection,cannot be easily carried,and it can produce endogenous antibodies when it enters the human body,so it is used for a long time.Tolerance can develop.Eltrombopag is an oral non-peptide thrombopoietin receptor agonist,which can stimulate the differentiation and proliferation of megakaryocytes,increase the production of platelets,and does not produce endogenous antibodies.Numerical adjustment of drug dose,therefore,eltrombopag may be a more effective and convenient treatment for malignant lymphoma CIT.PurposeThe purpose of this study was to investigate whether the clinical efficacy and safety of eltrombopag in the treatment of thrombocytopenia in malignant lymphoma after chemotherapy are comparable to those of recombinant human thrombopoietin(rhTPO)and whether the simul-taneous application of the two drugs can achieve better effects,and the purpose is to provide a theoretical reference for the treatment of patients with thrombocytopenia after chemotherapy for malignant lymphoma in the future.Methods1.Retrospectively collected 227 patients with malignant lymphoma diagnosed by histopathology who were diagnosed and treated in the Department of Hematology,The First Affiliated Hospital of Guangdong Pharmaceutical University from April 2017 to December 2021,and who developed grade 3(platelet count≥25×10~9/L,and<50×10~9/L)or 4(platelet count<25×10~9/L))thrombocytopenia after chemotherapy.patients as study subjects.60 patients received eltrombopag therapy(eltrombopag group),80patients received rhTPO therapy(rhTPO group),and 23 patients received both Received eltrombopag and rhTPO treatment(eltrombopag combined with rhTPO group)and 64 patients received no drug treatment(control group).2.Compare the four groups of patients in terms of baseline data,including demographics,clinical characteristics,whether there are statistical differences,and compare the white blood cell count,neutrophil count,hemoglobin value,alanine aminotransferase,alanine aminotrans-ferase,aspartate aminotransferase,total bilirubin,serum creatinine,CD4+/CD8+ratio,IL-2,IL-4,IL-6,IL-10,IFN-γ,TNF,regulatory T cells.3.The mean platelet value(PLT)and the lowest platelet count(lowest platelet value observed after treatment or in combination observed)were compared among the three treatment groups after treatment and the control group on the 0th,3rd,5th,7th,and 10th days,compare the continuous days of platelet value<50×10~9/L,and the days required to recover to≥50×10~9/L and≥75×10~9/L after treatment in the three treatment groups and the control group after enrollment.Compared the bleeding and platelet transfusion of the three treatment groups after treatment and the control group after entering the group.4.Comparison of the incidence of adverse events(AEs)among the three treatment groups.Results1.There were no statistically significant differences in baseline data,including demographics and clinical characteristics among the four groups of patients,and they were comparable.2.Among the experimental indicators,the white blood cell count,neutrophil count,hemoglobin value,alanine aminotransferase,aspartate aminotransferase,total bilirubin,serum creatinine,CD4+/CD8+ratio,IL-2.There was no statistical difference in IL-4,IL-6,IL-10,IFN-γ,TNF and regulatory T cells.3.There was no significant difference in the mean platelet values between the three treatment groups after treatment and the control group on the 0th and 3rd day(P>0.05).The mean platelet count of the group at the lowest platelet level,the 5th day,the 7th day and the 10th day was higher than that of the control group.There was no difference between the two groups(P>0.05).On the 10th day,there was no significant difference between the eltrombopag group and the rhTPO group,but there was a difference between the eltrombopag group,the rhTPO group and the eltrombopag combined with rhTPO group,respectively(P<0.05).The continuous days of platelet count<50×10~9/L and the number of days required for platelet count to recover to≥50×10~9/L had no significant difference among the three treatment groups,but were significantly shorter than those of the control group(P<0.01).Likewise,the days required for platelet recovery to≥75×10~9/L were significantly shorter in all three treatment groups than in the control group,and the eltrombopag combined with rhTPO group had further days than either the eltrombopag group or the rhTPO group.shortened(P<0.05).The bleeding rate and platelet transfusion rate of the patients in the eltrombopag group,rhTPO group,and eltrombopag combined with rhTPO group were lower than those in the control group.4.Treatment-related adverse events were reported in 9 patients(15.0%)in the eltrombopag group,8 patients(10.0%)in the rhTPO group,and 2 patients(8.7%)in the eltrombopag combined with rhTPO group,all of which were mild.and ephemeral.ConclusionEltrombopag can achieve similar clinical efficacy as rhTPO in the treatment of lymphoma thrombocytopenia after chemotherapy,and it is also safe and well tolerated.Eltrombopag can be used as an alternative treatment option for CIT in patients with lymphoma,and when the two drugs are combined,it can achieve better clinical efficacy.Optimal treatment outcomes,including increased platelet counts,prolonged platelet response times,reduced bleeding frequency,and reduced platelet transfusion requirements.Eltrombopag is well tolerated in the real world and does not raise additional concerns about hepatobiliary toxicity. |
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