QLTI-08. Single institution experience with romiplostim for chemotherapy-induced thrombocytopenia in gliomas

BACKGROUND Cytotoxic chemotherapy such as temozolomide, lomustine, procarbazine and platinum agents are the mainstay of glioma treatment. These medications cause dose-dependent thrombocytopenia which can lead to chemotherapy dose reductions and delays. Consensus guidelines suggest the thrombopoietin receptor antagonist romiplostim for treatment of chemotherapy induced thrombocytopenia (CIT); however, literature supporting its use in patients with gliomas treated with temozolomide is limited. We sought to explore the utility of romiplostim in glioma patients with CIT at our institution. METHODS Glioma patients who received at least 1 dose of romiplostim for CIT after any cytotoxic chemotherapy from 6/1/2020-5/31/2025 were included in this retrospective analysis. Primary objective was to evaluate the number of days to achieve a platelet count of ≥ 100,000/µL from time of romiplostim initiation. Secondary objectives included romiplostim dose (mcg/kg) at platelet count ≥ 100,000/µL, final romiplostim dose, number of platelet transfusions, and any documented major bleeding or clotting events. RESULTS Eight patients received 112 doses (range 2-46) of romiplostim during the time period. All 8 patients were either currently taking or previously took temozolomide. Median number of days to platelet count ≥ 100,000/µL was 27.5. Median dose at platelet count ≥ 100,000/µL was 3.5 mcg/kg (range: 1-10 mcg/kg; IQR: 5 mcg/kg), with a median final dose of 5 mcg/kg. Five patients required a total of 39 platelet transfusions, with no reported major bleeding events. There were no reports of new blood clots on romiplostim; however, 1 patient was already receiving therapeutic anticoagulation. CONCLUSIONS This single institution review provides evidence for the use of romiplostim to treat CIT in patients with glioma previously treated with temozolomide with no documented adverse events. Further studies are needed to examine if higher doses of romiplostim may be required to prevent CIT and continue chemotherapy without dose reduction.