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Chemotherapy Induced Thrombocytopenia in Ewing Sarcoma, Implications and Potential for Romiplostim Supportive Care
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  • Nawal Merjaneh,
  • Jennifer Young,
  • Avani Mangoli,
  • Mallery Olsen,
  • Bhuvana Setty,
  • Adam Lane,
  • Rajaram Nagarajan,
  • Joseph Pressey,
  • Brian Turpin
Nawal Merjaneh
Cincinnati Children's Hospital Medical Center

Corresponding Author:[email protected]

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Jennifer Young
Cincinnati Children's Hospital Medical Center
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Avani Mangoli
Duke University
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Mallery Olsen
Nationwide Children's Hospital
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Bhuvana Setty
Nationwide Children's
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Adam Lane
Cincinnati Children\'s Hospital Medical Center
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Rajaram Nagarajan
Children's Hospital Cincinnati
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Joseph Pressey
Cincinnati Children's Hospital Medical Center
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Brian Turpin
Cincinnati Children's Hospital Medical Center
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Background: Maintaining dose-dense, interval-compressed chemotherapy improves survival in Ewing sarcoma patients but is limited by myelosuppression. Romiplostim is a thrombopoietin receptor agonist that may be useful in the treatment of chemotherapy-induced thrombocytopenia (CIT). Methods: Patients aged between 3 and 33 years with Ewing sarcoma from 2010-2020 were reviewed. CIT was defined as a failure to achieve 75,000 platelets per microliter by day 21 after the start of any chemotherapy cycle. Fisher exact test was used for univariate analysis and Pearson’s correlation coefficient was used for the association between continuous variables. Results: 27 out of 42 patients (64%) developed isolated CIT, delaying one to four chemotherapy cycles per patient. CIT occurred during consolidation therapy in 24/27(88.9%) and with ifosfamide/etoposide cycles in 24/27 (88.9%). Univariate analysis failed to identify risk factors for CIT. The use of radiation approached significant (p value=0.056). Ten patients received romiplostim. The median starting dose was 3 (range 1-5) mcg/kg. Doses were escalated weekly by 1-2 mcg/kg to 4-10 mcg/kg and continued throughout chemotherapy. A higher romiplostim dose was associated with a higher change in average platelet counts from baseline r= 0.73 (p=0.04). No romiplostim-related adverse events were identified aside from mild headache. Conclusions: CIT is the primary reason for the inability to maintain treatment intensity in Ewing sarcoma. The concurrent use of romiplostim with chemotherapy is safe and feasible, and efficacy was associated with higher romiplostim doses.
20 Oct 2021Submission Checks Completed
20 Oct 2021Assigned to Editor
20 Oct 2021Submitted to Pediatric Blood & Cancer
21 Oct 2021Reviewer(s) Assigned
10 Nov 2021Review(s) Completed, Editorial Evaluation Pending
11 Nov 2021Editorial Decision: Revise Minor
24 Nov 2021Submission Checks Completed
24 Nov 2021Assigned to Editor
24 Nov 20211st Revision Received
26 Nov 2021Reviewer(s) Assigned
08 Dec 2021Review(s) Completed, Editorial Evaluation Pending
08 Dec 2021Editorial Decision: Accept
Jul 2022Published in Pediatric Blood & Cancer volume 69 issue 7. 10.1002/pbc.29548