Avatrombopag Reduces Platelet Transfusion Requirement in Thrombocytopenia Subsequent to Antineoplastic Therapies in Haematological Patients: The Experience of a Tertiary Centre

TL;DR

Avatrombopag helps reduce the need for platelet transfusions in cancer patients with low platelet counts after chemotherapy.

Contribution

This study provides new evidence on the efficacy of avatrombopag in haematological patients with chemotherapy-induced thrombocytopenia.

Findings

82.6% of patients responded to avatrombopag, with most showing improvement within 4 weeks.

Transfusion requirements significantly decreased after avatrombopag treatment.

No patients delayed or reduced chemotherapy, and no safety issues were reported.

Abstract

Background/Objectives: Thrombocytopenia subsequent to antineoplastic therapies leads to bleeding complications, treatment delay or de-intensification, and platelet transfusion requirement. Evidence suggests that thrombopoietin receptor agonists (TPO-RAs) can restore platelet counts in this scenario. Avatrombopag (AVA) is an oral TPO-RA whose efficacy in treating thrombocytopenia in haematological malignancy has been barely addressed. We aimed to evaluate AVA’s efficacy in improving platelet recovery and reducing transfusion requirement in haematological patients with thrombocytopenia. Methods: In this retrospective observational study, haematological patients who developed thrombocytopenia persisting for ≥3 weeks and were treated with AVA between November 2023 and December 2024 were recruited. Results: Twenty-three patients were recruited. Nineteen (82.6%) responded to AVA, most within the first 4 weeks: 10 (43.5%) and 9 (39.1%) achieved platelet counts ≥ 30 × 109/L (partial response) and ≥100 × 109/L (complete response), respectively. Response was always maintained for 30 days after AVA withdrawal. Transfusions were significantly fewer than in the previous period: 0 (0–8) vs. 11 (2–15), median (interquartile range [IQR]), p = 0.007. Once on treatment, 13 (56.5%) patients no longer required transfusion. No patient delayed or de-intensified chemotherapy. No safety concerns were reported. Conclusions: AVA shows promise in safely reducing thrombocytopenia-associated transfusion needs in haematological malignancy.

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