肿瘤治疗相关血小板减少症的治疗：海曲泊帕联合特比澳的病例系列和文献综述

Hetrombopag Combined with TPIAO^® for Treating Cancer Therapy-Related Thrombocytopenia: A Case Series and Literature Review

摘要: 肿瘤治疗引发的血小板减少症(CTIT)常见于临床，主要导致出血、治疗推迟和生存率降低。通常治疗采用注射型重组人血小板生成素特比澳(rhTPO)。新一代口服药物海曲泊帕，一种血小板生成素受体激动剂，在中国获批用于治疗成人原发性免疫性血小板减少症(ITP)和重型再生障碍性贫血(SAA)。相较于特比澳，海曲泊帕的口服形式更适合CTIT的院外管理和二级预防。但是，海曲泊帕与特比澳联合治疗CTIT的文献评估尚缺。因此，治疗决策取决于医疗服务提供者的判断。特别地，该联合治疗使得血小板计数显著提高，尤其是在13天内从26 × 10⁹/L增至121 × 10⁹/L，文中的病例将为肿瘤患者血小板减少症管理提供了新的视角。总之，本研究通过四例获益于特比澳与海曲泊帕联合治疗的病例提出了CTIT治疗的新策略，此外全面的文献回顾深化了对不同治疗方式引发血小板减少症复杂机制的理解，为研究海曲泊帕与rhTPO协同效应奠定了基础。从广义上看，本研究突显了癌症治疗中新型联合疗法的重要性，并强调了血液学和肿瘤学领域需进一步研究与探索。这些发现有望提升癌症患者的生活质量与治疗效果，对医学界产生广泛影响。

Abstract: Cancer therapy-induced thrombocytopenia (CTIT), a common clinical challenge, often results in bleeding, treatment postponements, and decreased survival rates. The standard approach involves administering recombinant human thrombopoietin (rhTPO) via injection. Eltrombopag, an orally administered thrombopoietin receptor agonist, recently approved in China, offers treatment for adult primary immune thrombocytopenia (ITP) and severe aplastic anemia (SAA). This oral medication presents a preferable option for the outpatient management and secondary prevention of CTIT compared to rhTPO. Nonetheless, there is a scarcity of literature on the efficacy of combining Eltrombopag and rhTPO in treating CTIT, making treatment decisions dependent on the discretion of healthcare providers. Remarkably, this combination therapy has significantly elevated platelet counts, with a notable increase from 26 × 10⁹/L to 121 × 10⁹/L within 13 days, providing a fresh outlook on managing thrombocytopenia in cancer patients. This study proposes a novel CTIT management strategy, evidenced by four cases benefiting from the combined use of Eltrombopag and rhTPO. A thorough literature review has enhanced the understanding of the intricate mechanisms of thrombocytopenia caused by various treatments, setting the stage for future research on the synergistic effects of Eltrombopag and rhTPO. Overall, this research highlights the importance of innovative combined therapies in cancer care and underscores the necessity for further studies in hematology and oncology. The findings suggest a potential for significantly improving life quality and treatment outcomes for cancer patients, thereby impacting the medical field profoundly.