Thrombocytopenia is a common hematologic adverse reaction to cancer treatment, which can increase the risk of bleeding, prolong hospitalization, increase medical costs, and in severe cases, lead to death. Recently, the “7th Beijing Thrombosis and Hemostasis Conference and the 5th Beijing Hematology Oncology and Immunology Summit Forum”, hosted by the Chinese Society of Immunology Hematology Branch and organized by the National Clinical Research Center for Hematologic Diseases-Peking University Institute of Hematology and Beijing Hospital of Peking University, was held successfully in Beijing from March 1st to 3rd, 2024. After the conference, Oncology Frontier – Hematology Frontier invited Professor Hu Zhou from Henan Cancer Hospital to share the diagnosis and treatment progress of tumor-related thrombocytopenia.
Oncology Frontier – Hematology Frontier: Cancer treatment-related thrombocytopenia is a common adverse reaction to antitumor drugs. What factors need to be considered when treating patients with thrombocytopenia?
Professor Hu Zhou: There are many factors related to cancer treatment-related thrombocytopenia (CTIT), previously known as chemotherapy-induced thrombocytopenia, which is mostly associated with the toxic side effects of chemotherapy drugs. Chemotherapy may cause bone marrow suppression, leading to the destruction of megakaryocytes and subsequently reducing platelet production. With the development of immunotherapy and targeted therapy, new drugs such as ADCs have emerged, which may cause cross-immune damage, including off-target effects of targeted drugs such as PD-1 and PD-L1. Studies have found that platelets express PD-L1 receptors on their surface, and targeted drugs such as PD-1 and PD-L1 may directly attack platelets, leading to thrombocytopenia. In summary, the mechanism of tumor-related thrombocytopenia is complex, and multiple factors need to be considered during treatment.
Oncology Frontier – Hematology Frontier: Last year, the guidelines for cancer treatment-related thrombocytopenia were updated. Could you share some updates in terms of treatment?
Professor Hu Zhou: In 2023, the “Guidelines for the Diagnosis and Treatment of Cancer Treatment-Related Thrombocytopenia (2023 Edition)”, led by Professor Ma Jun, were updated, with two-tier recommendations for the use of thrombopoietin receptor agonists (TPO-RAs) and recombinant human thrombopoietin (rhTPO) therapy. Currently, for CTIT, there are more treatment options available, including novel drugs such as romiplostim, avatrombopag, and lusutrombopag, which have shown good efficacy in single-center or small-sample data. For example, phase II data of avatrombopag show good treatment efficacy, so the guidelines also include these new drugs to increase the treatment rate in clinical practice and improve patient quality of life.
Oncology Frontier – Hematology Frontier: With the development of precision treatment concepts, there are increasingly more targeted drugs available. How should we comprehensively diagnose and treat thrombocytopenia caused by targeted therapy?
Professor Hu Zhou: In the process of cancer treatment, if thrombocytopenia occurs, the diagnosis should be clarified first. There are many reasons for tumor treatment-related thrombocytopenia, which should be evaluated by hematologists and comprehensively analyzed to determine the specific causes: whether it is caused by chemotherapy-induced megakaryocyte dysfunction, off-target effects of targeted drugs, cross-immune damage, or immune thrombocytopenia mediated by autoantibodies. Secondly, if thrombocytopenia is indeed caused by off-target effects, immunosuppressive agents such as intravenous immunoglobulin and steroids are recommended as the first choice due to their good efficacy.
Professor Hu Zhou
Henan Cancer Hospital (Zhengzhou University Affiliated Cancer Hospital)
Chief Physician, Professor, Doctoral Supervisor
Ph.D., Deputy Director of Hematology, Henan Cancer Hospital
Director of Anemia, Hemostasis and Thrombosis Division, Henan Cancer Hospital
Director of Hemostasis and Thrombosis Diagnostic Research Center, Henan Province
Leading Talent of Henan Provincial Health Commission
Committee Member of the Hemostasis and Thrombosis Group of the Chinese Society of Hematology
Committee Member of the Chinese Society of Gerontology Hematology Branch
Committee Member of the Chinese Physiology Society Hemostasis and Thrombosis Special Committee
Vice Leader of the China Hemophilia Collaborative Group for Rare Diseases
Standing Committee Member of the China Hemophilia Committee of the China Alliance for Rare Diseases
Vice Chairman of the Hemostasis and Thrombosis Group of the Hematology Professional Committee of Henan Province
Editorial Board Member of “Thrombosis and Hemostasis”, “Hematology”, and “Chinese Edition of BLOOD” Journals
Principal Investigator of 2 National Natural Science Foundation Projects
Editor-in-Chief and Co-author of 5 monographs, including “Hematology” and “Difficult Cases in Internal Medicine” Series
