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- W2168543180 abstract "In this edition of Leukemia and Lymphoma , Greenberg and colleagues report the results of their eff ort to fi nd a signal of activity of the thrombopoeitin (TPO)-mimetic agent romiplostim when combined with decitabine for the treatment of myelodysplasia (MDS) [1]. Th e clinical and methodological questions raised by this study are important, and speak to both the potential role of the TPO-receptor agonists as supportive care agents in myelodysplasia, and the scientifi c and methodological pitfalls of clinical development in this particularly heterogeneous target population. As the authors acknowledge, the sample size of this trial is insuffi cient to allow any statistically sound conclusions about the effi cacy of the TPO-mimetic. Nevertheless, the observations regarding tolerability and a signal of drug activity are of interest. Th e context of these trials is the historical concern that activation of c-mpl, the target of TPO, may promote acute myeloid leukemia (AML) blast survival [2 – 4] and increase the rate of progression of MDS to AML [5]. Transient elevations of the marrow blast count to greater than 20% were noted in four of 41 patients in the phase II study of romiplostim monotherapy in patients with lower risk MDS, all falling to 10% after withdrawal of the drug [6]. Another two of 41 patients progressed to AML, probably consistent with the natural history of the disease. One hypothesis for this eff ect is that activation of the mpl receptor has a stem-cell mobilizingeff ect, a hypothesis supported by clinical observations from trials of recombinant TPO [7]. Amgen have recently issued a formal notice of a risk of progression of International Prognostic System Score (IPSS) low- and intermediate-1 MDS to AML [8] in patients receiving romiplostim, a consequence of early data from the placebo-controlled randomized trial of the drug as monotherapy in patients with lower risk MDS [9]. Meanwhile Glaxo-Smith-Kline (GSK) continues its development of the small molecule mpl agonist eltrombopag in this fi eld, including studies in patients with higher risk MDS than those selected for the romiplostim studies, with no sugges" @default.
- W2168543180 created "2016-06-24" @default.
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- W2168543180 date "2012-11-07" @default.
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- W2168543180 title "Supportive care for thrombocytopenia in patients receiving treatment for myelodysplasia: a challenge for the future" @default.
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- W2168543180 doi "https://doi.org/10.3109/10428194.2012.738817" @default.
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