THROMBOCYTOPENIA IN PATIENTS WITH MYELODYSPLASTIC SYNDROMES - STILL AN UNSOLVED PROBLEM
The myelodysplastic syndromes (MDS) are a group of clonal bone marrow (BM) stem cell disorders, characterized by ineffective hematopoiesis, peripheral cytopenias and hematologic cellular dysfunction, as well as potential transformation to acute leukemia. Thrombocytopenia is common in MDS and is ass...
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PAGEPress Publications
2018-07-01
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| Series: | Mediterranean Journal of Hematology and Infectious Diseases |
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| Online Access: | https://www.mjhid.org/index.php/mjhid/article/view/3463 |
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| author | May Basood Howard S. Oster Moshe Mittelman |
| author_facet | May Basood Howard S. Oster Moshe Mittelman |
| author_sort | May Basood |
| collection | DOAJ |
| description | The myelodysplastic syndromes (MDS) are a group of clonal bone marrow (BM) stem cell disorders, characterized by ineffective hematopoiesis, peripheral cytopenias and hematologic cellular dysfunction, as well as potential transformation to acute leukemia.
Thrombocytopenia is common in MDS and is associated with bleeding complications, occasionally life threatening. Low platelet count (PLT), as well declining PLT also serves as a prognostic marker. Understanding thrombopoiesis led to the cloning of thrombopoietin, resulting in the development of platelet stimulating agents, thrombomimetics, romiplostim and eltrombopag.
Both agents have been shown to increase PLT, decrease the need for platelet transfusions and reduce the number of bleeding episodes, with a reasonable tolerance. They are already approved for immune thrombocytopenia and thrombocytopenia related to liver disease.
Romiplostim and eltrombopag have proven efficacy in lower- and higher-risk MDS with thrombocytopenia, as monotherapy, as well as a part of a combination, either with lenalidomide, and mainly combined with hypomethylating agents. However, safety concerns have been raised: while several trials have been completed with no evidence of disease progression, others have been early terminated due to increased number of BM blasts and possible leukemic transformation in treated-patients. The jury is still out regarding this safety concern, although recent publications are more encouraging.
Keywords: Myelodysplastic syndrome, Thrombocytopenia, Thrombomimetics,
Romiplostim, Eltrombopag. |
| format | Article |
| id | doaj-art-3384d5853da841f4a1697090449d558d |
| institution | DOAJ |
| issn | 2035-3006 |
| language | English |
| publishDate | 2018-07-01 |
| publisher | PAGEPress Publications |
| record_format | Article |
| series | Mediterranean Journal of Hematology and Infectious Diseases |
| spelling | doaj-art-3384d5853da841f4a1697090449d558d2025-08-20T02:51:02ZengPAGEPress PublicationsMediterranean Journal of Hematology and Infectious Diseases2035-30062018-07-01101e2018046e201804610.4084/mjhid.2018.0461765THROMBOCYTOPENIA IN PATIENTS WITH MYELODYSPLASTIC SYNDROMES - STILL AN UNSOLVED PROBLEMMay Basood0Howard S. OsterMoshe Mittelman1may_basood@yahoo.comDepartment of Medicine, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel, IsraelThe myelodysplastic syndromes (MDS) are a group of clonal bone marrow (BM) stem cell disorders, characterized by ineffective hematopoiesis, peripheral cytopenias and hematologic cellular dysfunction, as well as potential transformation to acute leukemia. Thrombocytopenia is common in MDS and is associated with bleeding complications, occasionally life threatening. Low platelet count (PLT), as well declining PLT also serves as a prognostic marker. Understanding thrombopoiesis led to the cloning of thrombopoietin, resulting in the development of platelet stimulating agents, thrombomimetics, romiplostim and eltrombopag. Both agents have been shown to increase PLT, decrease the need for platelet transfusions and reduce the number of bleeding episodes, with a reasonable tolerance. They are already approved for immune thrombocytopenia and thrombocytopenia related to liver disease. Romiplostim and eltrombopag have proven efficacy in lower- and higher-risk MDS with thrombocytopenia, as monotherapy, as well as a part of a combination, either with lenalidomide, and mainly combined with hypomethylating agents. However, safety concerns have been raised: while several trials have been completed with no evidence of disease progression, others have been early terminated due to increased number of BM blasts and possible leukemic transformation in treated-patients. The jury is still out regarding this safety concern, although recent publications are more encouraging. Keywords: Myelodysplastic syndrome, Thrombocytopenia, Thrombomimetics, Romiplostim, Eltrombopag.https://www.mjhid.org/index.php/mjhid/article/view/3463Myelodysplastic SyndromeThrombocythopeniaThrombomimetics |
| spellingShingle | May Basood Howard S. Oster Moshe Mittelman THROMBOCYTOPENIA IN PATIENTS WITH MYELODYSPLASTIC SYNDROMES - STILL AN UNSOLVED PROBLEM Mediterranean Journal of Hematology and Infectious Diseases Myelodysplastic Syndrome Thrombocythopenia Thrombomimetics |
| title | THROMBOCYTOPENIA IN PATIENTS WITH MYELODYSPLASTIC SYNDROMES - STILL AN UNSOLVED PROBLEM |
| title_full | THROMBOCYTOPENIA IN PATIENTS WITH MYELODYSPLASTIC SYNDROMES - STILL AN UNSOLVED PROBLEM |
| title_fullStr | THROMBOCYTOPENIA IN PATIENTS WITH MYELODYSPLASTIC SYNDROMES - STILL AN UNSOLVED PROBLEM |
| title_full_unstemmed | THROMBOCYTOPENIA IN PATIENTS WITH MYELODYSPLASTIC SYNDROMES - STILL AN UNSOLVED PROBLEM |
| title_short | THROMBOCYTOPENIA IN PATIENTS WITH MYELODYSPLASTIC SYNDROMES - STILL AN UNSOLVED PROBLEM |
| title_sort | thrombocytopenia in patients with myelodysplastic syndromes still an unsolved problem |
| topic | Myelodysplastic Syndrome Thrombocythopenia Thrombomimetics |
| url | https://www.mjhid.org/index.php/mjhid/article/view/3463 |
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