Abstract
Background and Introduction: During Autologous stem cell transplant, one of the dreaded complications is Grade 4 thrombocytopenia, which leads to prolonged hospitalization and increased transfusion requirement. This pilot study aims to evaluate the efficacy and safety of prophylactic romiplostim in preventing grade 4 thrombocytopenia in this patient population.
Methods: From January 2024 to march 2025, an open label pilot study was conducted with 26 eligible adult patients undergoing Autologous stem cell transplant in a tertiary care oncology center. Beginning from day +1 post-transplant Romiplostim (250 mcg SC) was administered weekly until platelet engraftment. Results were compared with historical controls who did not receive romiplostim. Complete blood counts, transfusion requirements, adverse events and engraftment timelines were assessed on daily basis and documented. Statistical analysis was performed using appropriate comparative methods; p<0.05 was considered significant.
Results: Use of romiplostim reduced the incidence of grade 4 thrombocytopenia in multiple myeloma patients who received melphalan- 200mg/m2 as conditioning regimen (27.3% reduction, p=0.04). Also, there was a significant reduction in single donor platelet transfusion requirement in this group(p=0.03). Platelet engraftment was faster across all conditioning regimens in the intervention group. Neutrophil engraftment and duration of hospital stay were comparable. There were no major bleeding or thrombotic adverse events reported. An exploratory cost benefit analysis showed potential economic advantages due to decreased transfusion requirements.
Conclusion: Prophylactic romiplostim administration during Autologous stem cell transplant is a safe, effective intervention in reducing grade 4 thrombocytopenia and platelet transfusion requirements. Larger studies are warranted to confirm these findings.