Romiplostim for chemotherapy induced thrombocytopenia in pediatric cancers.

Authors

Shivam Bansal, Aditya Kumar Gupta, Jagdish Prasad Meena, Tushar Sehgal, Rachna Seth

Published in

British journal of cancer. Jul 25, 2026. Epub Jul 25, 2026.

Abstract

Chemotherapy-induced-thrombocytopenia (CIT) compromises cancer care, but data on its management in children is scarce. Romiplostim, a thrombopoietin-receptor-agonist, has shown efficacy in adults with CIT, though its role in paediatric patients remains undefined.
We conducted an investigator-initiated, open-label, randomized-controlled-trial at a tertiary center in India to evaluate prophylactic romiplostim for prevention of CIT in children aged 1-14 years with acute myeloid leukemia (AML), non-Hodgkin's lymphoma (NHL), and solid-tumors receiving myelosuppressive chemotherapy. Patients were randomly assigned (1:1) to receive romiplostim (3 μg/kg-subcutaneously) or standard-care. The primary outcome was platelet recovery (≥100 × 10⁹/L and transfusion-free for 72 hours) within 3-weeks. Secondary outcomes included bleeding, transfusion requirements, chemotherapy delays, and immature platelet fraction percentagecIPF%) trends.
From March 2023 to October 2024, 93 patients (median age, 3 years; interquartile range [IQR], 2-5) were randomized (47 intervention, 46 control). Platelet recovery occurred in 91.3% and 88.1%, respectively (risk difference, 3.2 percentage points; 95% confidence interval [CI], -9.5 to 15.9; P = 0.73). Clinically significant bleeding (≥WHO grade 2) occurred in none of 46 patients in romiplostim group and 6 of 43 (14%) in control group (absolute risk difference,-14 percentage points; 95% CI, -27 to -2; P = 0.01). Median platelet transfusion volume was lower with romiplostim (19.3 vs. 29.6 mL/kg; median difference, -10.3 mL/kg; 95% CI, -21.5 to 0.9; P = 0.06, rank-biserial correlation= 0.35). Romiplostim significantly increased IPF% on day-16 from baseline (258% vs. 47.7%, p = 0.016, Cohen's h = 2.41). No thrombotic events occurred.
Prophylactic romiplostim didn't hasten platelet recovery in pediatric patients receiving myelosuppressive chemotherapy but was associated with reduced bleeding and had lower transfusion requirements. There was a significant relative immature platelet fraction percentage (IPF)% increment on day 16 in the romiplostim arm in comparison to the control arm, reinforcing the biological plausibility of romiplostim's effect on megakaryocyte stimulation.
Clinical Trials Registry of India: CTRI/2023/02/049906.

PMID:
42502080
Bibliographic data and abstract were imported from PubMed on 26 Jul 2026.

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