Patients with chronic lymphocytic leukemia (CLL) are prone to developing autoimmune cytopenias (AICs). The second most common form of AIC is immune thrombocytopenia (ITP), which results in low levels of platelets necessary for coagulation.

In a case study published in Case Reports in Hematology, investigators treated a patient with CLL-associated ITP that was unresponsive to conventional treatment methods, with an FDA approved drug called eltrombopag that increased platelet count. This is the first study to document the use of thrombopoetin (TPO) receptor agonists in treating ITP that is secondary to CLL.1

“Our case illustrates how TPO mimetic drugs can be safely administered over long periods of time, helping to keep platelet counts above life-threatening levels and preserving the immune system because they are non-immunosuppressive drugs,” write the investigators.

The study reports on a 69-year-old male patient with CLL-associated ITP and a history chronic auricular fibrillation who was hospitalized with signs of congestive heart failure. Anticoagulant therapy was suggested to mitigate thromboembolic risk, but the patient’s platelet count was too low (<50 × 109/L) due to ITP.

The investigators aimed to increase platelet count by treating ITP. However, the patient was unresponsive to traditional treatment methods including corticosteroids and intravenous immunoglobulins. Next, the investigators turned to thromobopeitin (TPO) receptor agonists, which have been shown to stimulate the thromobopeitin receptor and increase platelet count. The patient was treated daily with 50 mg of eltrombopag, an oral nonpeptide TPO receptor agonist used for the treatment of chronic idiopathic ITP that is unresponsive to corticosteroids, intravenous immunoglobulins, or splenectomy.

An initial platelet recovery of 120 × 109/L was observed, which allowed for the initiation of oral anticoagulant treatment with acenocoumarol. After 12 months of eltrombopag treatment the patient had a platelet count of 80 x 109/L, allowing for continued anticoagulation treatment. The combined treatment was maintained for 24 consecutive months with no observed adverse effects.

The authors conclude, “The possibility of administering TPO mimetic drugs in severely thrombocytopenic patients who need to initiate or maintain an anticoagulant therapy is of great interest. Our clinical experience demonstrates its feasibility in patients with ITP associated with CLL.

Reference

1. Miguel JSL, Jose GFJ. Successful long-term use of eltrombopag in a patient with refractory severe thrombocytopenia associated with chronic lymphocytic leukemia that allowed oral anticoagulant treatment for severe cardiomyopathy. Case Rep Hematol. 2017;2017:9538920. doi: 10.1155/2017/9538920