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01-10-2015 | Case Report

Identification of anti-thrombopoietin receptor antibody in prolonged thrombocytopenia after allogeneic hematopoietic stem cell transplantation treated successfully with eltrombopag

Authors: Akihito Fujimi, Yusuke Kamihara, Akari Hashimoto, Yuji Kanisawa, Chisa Nakajima, Naotaka Hayasaka, Shota Yamada, Toshinori Okuda, Shinya Minami, Kaoru Ono, Satoshi Iyama, Junji Kato

Published in: International Journal of Hematology | Issue 4/2015

Abstract

A 55-year-old female with stage IVA follicular lymphoma in third complete remission underwent allogeneic peripheral blood stem cell transplantation. Neutrophil engraftment was achieved on day +18; however, platelet counts remained below 10 × 10³/µL, necessitating transfusions twice a week for more than 3 months. Bone marrow showed a decreased number of megakaryocytes with hypolobulated nuclei. No graft versus host disease, viral infection, or disease relapse was observed. Furthermore, severe thrombocytopenia below 5.0 × 10³/µL refractory to transfusion appeared on day +240 after influenza virus infection. Treatments with intravenous immunoglobulin, romiplostim, and rituximab were administered without any recovery. Subsequently, eltrombopag was initiated on day +443, after which platelet counts rose gradually and continued to rise above 20 × 10³/µL after 10 weeks of administration. The serum thrombopoietin (TPO) level was markedly elevated, and anti-TPO receptor (TPOR) antibody was detected in the patient’s serum. Anti-TPOR antibody may play an important role in some cases of prolonged thrombocytopenia after allogeneic hematopoietic stem cell transplantation with unknown etiology, and eltrombopag could be a novel therapeutic option for such cases.

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Title: Identification of anti-thrombopoietin receptor antibody in prolonged thrombocytopenia after allogeneic hematopoietic stem cell transplantation treated successfully with eltrombopag
Authors: Akihito Fujimi
Yusuke Kamihara
Akari Hashimoto
Yuji Kanisawa
Chisa Nakajima
Naotaka Hayasaka
Shota Yamada
Toshinori Okuda
Shinya Minami
Kaoru Ono
Satoshi Iyama
Junji Kato
Publication date: 01-10-2015
Publisher: Springer Japan
Published in: International Journal of Hematology / Issue 4/2015
Print ISSN: 0925-5710
Electronic ISSN: 1865-3774
DOI: https://doi.org/10.1007/s12185-015-1806-0

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