Romiplostim as a Viable and Long-term Remedy for Refractory Immune Thrombocytopenia and Concomitant Small B-Cell Lymphoma

Abstract

Immune thrombocytopenia (ITP) is an acquired autoimmune disorder characterized by immune-mediated destruction of otherwise normal platelets and can be either primary, without obvious initiating or underlying cause, or secondary ITP due to an underlying disease or drug exposure. The goals of therapy for ITP include achieving an adequate platelet level for hemostasis and minimizing toxicities with current options including: corticosteroids, rituximab, splenectomy, intravenous gamma globulin (IVIG), Anti-D, and thrombopoietin receptor agonists (TPO) like romiplostim and eltrombopag. TPO mimetics like romiplostim have emerged as viable and practical option in relapsed and refractory ITP. We present a 70-year-old Caucasian male patient with chronic lymphocytic leukemia/small cell lymphoma (CLL/SLL) related secondary ITP who had been maintained for nearly a decade on romiplostim after failing all other options of therapy. We report this case to demonstrate the efficacy and sustainability of romiplostim use in the relapse/ refractory ITP in such a patient who failed to respond to other therapeutic options. Figure 1: Highlights bone marrow involvement of approximately five percent by mature neoplastic cells (H&E, 100x magnification). Citation: Ajebo G, Dainer P, Pantin J, Ryan N, Bruker C (2019) Romiplostim as a Viable and Long-term Remedy for Refractory Immune Thrombocytopenia and Concomitant Small B-Cell Lymphoma. J Blood Lymph 9: 236.