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Ecsedi M, Lengline É, Knol-Bout C, Bosman P, Eikema DJ, Afanasyev B, Maschan A, Dreger P, Halkes CJM, Drexler B, Cortelezzi A, Drénou B, Patriarca A, Bruno B, Onofrillo D, Lanino E, Pulanic D, Serventi-Seiwerth R, Garnier A, Ljungman P, Bonifazi F, Giammarco S, Tournilhac O, Pioltelli P, Rovó A, Risitano AM, de Latour RP, Dufour C, Passweg J. Use of eltrombopag in aplastic anemia in Europe. Ann Hematol 2019; 98:1341-1350. [PMID: 30915499 DOI: 10.1007/s00277-019-03652-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 03/02/2019] [Indexed: 11/30/2022]
Abstract
Eltrombopag (ELT), an oral thrombopoietin receptor agonist, has recently emerged as a promising new drug for the treatment of aplastic anemia (AA). How ELT is used outside of clinical trials in the real-world setting and results of this treatment are not known. We conducted therefore a retrospective survey on the use of ELT in AA among EBMT member centers. We analyzed the 134 patients reported in our survey together with 46 patients recently published by Lengline et al. The median follow-up from start of ELT treatment was 15.3 months, with 85.6% patients alive at last follow-up. Importantly, only 28.9% of our patients received ELT according to the FDA/EMA label as monotherapy in the relapsed/refractory setting, whereas 16.7% received ELT upfront. The overall response rate in our cohort was 62%, very similar to the results of the pivotal ELT trial. In multivariate analysis, combination therapy with ELT/cyclosporine/ATG and response to previous therapy were associated with response. Overall survival was favorable with a 1-year survival from ELT start of 87.4%. We identified age, AA severity before ELT start and response to ELT as variables significantly associated with OS. Two patients transformed to MDS; other adverse events were mostly benign. In sum, ELT is used widely in Europe to treat AA patients, mostly in the relapsed/refractory setting. Response to ELT is similar to the clinical trial data across different age groups, treatment lines, and treatment combinations and results in favorable survival.
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Affiliation(s)
- Matyas Ecsedi
- Department of Hematology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | | | | | | | | | - Boris Afanasyev
- First State Pavlov Medical University of St. Petersburg, St. Petersburg, Russia
| | - Alexei Maschan
- Dimitri Rogachev Federal Research Center for Pediatric Hematology, Oncology and Immunology of Russian Federation, Moscow, Russia
| | | | | | - Beatrice Drexler
- Department of Hematology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Agostino Cortelezzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, and University of Milan, Milan, Italy
| | | | - Andrea Patriarca
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | | | | | | | - Drazen Pulanic
- University Hospital Center and Medical School, University of Zagreb, Zagreb, Croatia
| | | | | | - Per Ljungman
- Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | | | - Alicia Rovó
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio M Risitano
- Hematology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | | | | | - Jakob Passweg
- Department of Hematology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
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