Service de Médecine Interne et Maladies Infectieuses, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac Cedex, France.
Int J Hematol. 2013 Nov;98(5):520-4. doi: 10.1007/s12185-013-1439-0. Epub 2013 Sep 26.
Romiplostim is a thrombopoietin-receptor agonist approved to treat chronic immune thrombocytopenia (ITP). We treated eight patients with acute or persistent primary ITP, severe clinical bleeding, and resistance to corticosteroids and/or intravenous immunoglobulins (IVIg). Romiplostim, initially administered at 2 or 3 μg/kg/week, was subsequently increased to achieve and maintain platelet-count responses and control bleeding. Seven patients' platelet counts rose above 30 G/L, representing ≥twofold increases, within a median of 14 days after 1-5 infusions. The weekly dose reached 9 μg/kg at week 5 for three patients; the other patients' ITPs were controlled with ≤6 μg/kg/week. No thromboembolic events occurred. Five patients received rituximab concomitantly with romiplostim, four of whom could stop romiplostim within 2 months, thereby demonstrating rituximab efficacy. All three patients treated with romiplostim alone required maintenance therapy. Thus, romiplostim represents an alternative for patients with severe acute or persistent ITP refractory to conventional therapy.
罗米司亭是一种血小板生成素受体激动剂，已被批准用于治疗慢性免疫性血小板减少症（ITP）。我们治疗了 8 例患有急性或持续性原发性 ITP、严重临床出血、且对皮质类固醇和/或静脉注射免疫球蛋白（IVIg）耐药的患者。罗米司亭最初以 2 或 3μg/kg/周的剂量给药，随后增加剂量以达到并维持血小板计数反应和控制出血。在 1-5 次输注后中位数为 14 天内，7 名患者的血小板计数上升至 30G/L 以上，代表增加了两倍以上。有 3 名患者在第 5 周时每周剂量达到 9μg/kg；其他患者的 ITP 用≤6μg/kg/周的剂量得到控制。未发生血栓栓塞事件。5 名患者同时接受利妥昔单抗和罗米司亭治疗，其中 4 名患者可在 2 个月内停用罗米司亭，从而证明利妥昔单抗有效。单独用罗米司亭治疗的 3 名患者均需要维持治疗。因此，罗米司亭是对常规治疗耐药的严重急性或持续性 ITP 患者的另一种选择。
