Prospective Study of Patients With Thrombocytopenia Following HSCT

Phase 3

Completed

Brief Summary: Isolated thrombocytopenia is a common and severe complication of HSCT, which often leads to an increased risk of life-threatening hemorrhage, frequent requirement of platelet transfusions and extended hospital stays, representing a challenging clinical problem. Current treatments for thrombocytopenia after HSCT are frequently unsatisfactory in platelet recovery and for preventing potentially fatal bleeding complications. Therefore, it is urgent to explore an effective therapy to improve the outcomes of thrombocytopenia after HSCT. Previous studies have demonstrated that decitabine, a hypomethylating agent, may reduce platelet transfusions in myelodysplastic syndrome (MDS) patients. The investigators conducted an prospective clinical trial to evaluate the safety and efficiency of rhTPO and decitabine in the treatment of thrombocytopenia following HSCT.

Detailed Description: Isolated thrombocytopenia is a frequent and severe complication of hematopoietic stem cell transplantation (HSCT). It often leads to an increased risk of life-threatening hemorrhage, frequent requirement of platelet transfusions and extended hospital stays, representing a challenging clinical problem. Current treatments for thrombocytopenia after HSCT, including thrombopoietin, interleukin-11, immunoglobulin, methylprednisolone and rituximab, are frequently unsatisfactory in platelet recovery. Therefore, it is urgent to explore an effective therapy to improve the outcomes of thrombocytopenia after HSCT. Thrombopoietin (TPO) is a cytokine that drives thrombopoiesis by stimulating the differentiation of stem cells into megakaryocytes and promoting megakaryocyte proliferation and polyploidization. Decitabine was approved for the treatment of myelodysplastic syndrome (MDS) as a DNA methylation inhibitors. Studies in vitro show that decitabine enhances platelet release and megakaryocyte maturation. Here, the investigators performed a prospective clinical trial, in order to investigate the safety and efficiency of rhTPO and decitabine in the treatment of thrombocytopenia following HSCT.

Recruitment & Eligibility

Inclusion Criteria

Platelet count ≤ 30 × 109/L persistently at day 60 post-HSCT or later;
Neutrophil and hemoglobin were well recovered;
Full donor chimerism was achieved;
No response to conventional treatments (e.g. thrombopoietin, immunoglobulin, glucocorticoid alone or in combination) for a duration of at least 4 weeks;

Exclusion Criteria

Patients with malignancy relapse;
Active infections;
Grade Ⅲ-Ⅳ acute GVHD or severe chronic GVHD according to National Institute of Health criteria;
Severe organ damage;
Thrombosis requiring treatment;
Received decitabine following the current transplantation.

Arm && Interventions

Group	Intervention	Description
Experimental Group 1	Decitabine	Decitabine in combination with rhTPO.
Experimental Group 1	rhTPO	Decitabine in combination with rhTPO.
Experimental Group 2	Decitabine	Decitabine
Control Group	Conventional Treatment	Conventional treatment except decitabine.

Primary Outcome Measures

Name	Time	Method
Number of Participants With Platelet Count Recovery	Up to 4 weeks after the treatment	Platelet response refers to a sustained increase (stable or increasing level) of at least 30×10E9/L independent of transfusion for 3 days.

Secondary Outcome Measures

Name	Time	Method
Megakaryocyte Count	Up to 4 weeks after the treatment	The total number of megakaryocytes as well as the platelet-shedding megakaryocytes of bone marrow smears (per cm2) was counted and cross-checked by blinded observers.