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Chemotherapy-induced thrombocytopenia

What's new

Added 2024 ISTH, 2022 ESMO, 2018 ASCO, and 2017 BCSH guidelines for the management of chemotherapy-induced thrombocytopenia.

Background

Overview

Definition
CIT is a common complication of antineoplastic therapy, characterized by a decrease in platelet count, which can lead to treatment delays, dose reductions, and discontinuation of therapy due to the risk of bleeding events.
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Pathophysiology
The pathophysiology of CIT involves the direct toxic effects of chemotherapy on bone marrow, specifically on megakaryocytes, which leads to decreased production of new platelets. Additionally, chemotherapy can increase the rate of platelet destruction, further contributing to the reduction in platelet count.
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Risk factors
Risk factors for CIT include the type of cancer, the specific chemotherapy regimen used, and individual patient characteristics. CIT is more common in patients with hematologic malignancies (approximately half of cases) than in those with solid tumors (about one-third). Thrombocytopenia is reported in 37% of patients receiving gemcitabine and 31% of those treated with platinum-based chemotherapy. Other potential risk factors are renal impairment or liver disease, advanced age, and baseline platelet count.
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Guidelines

Key sources

The following summarized guidelines for the management of chemotherapy-induced thrombocytopenia are prepared by our editorial team based on guidelines from the International Society on Thrombosis and Haemostasis (ISTH 2024), the European Society of Medical Oncology (ESMO 2022), the American Society of Clinical Oncology (ASCO 2018), and the British Committee for Standards In Haematology (BCSH 2017). ...
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Medical management

Thrombopoietin receptor agonists: as per ISTH 2024 guidelines, consider enrolling patients in a clinical trial when considering the use of thrombopoietin receptor agonists.
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Therapeutic procedures

Platelet transfusion: as per ISTH 2024 guidelines, administer empirical platelet transfusion in patients with a platelet count < 10×10⁹/L.
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