Table 1.

Management of thrombocytopenia in MDS

Non-pharmacologic Management	Advantages	Disadvantages
Platelet Transfusions	Effective and rapid response	Response short-lived, costly, limited by availability, refractoriness, transmission of infections, inconvenient
Chemotherapy dose/delays	Allow platelets to recover	Potentially reduce antitumor effect and reduce survival
Pharmacologic Management
Immunosuppressive agents Cyclosporin +/− Antithymocyte Globulin	Cyclosporin;oral formulation	Cyclosporin; Monitor levels, hypertension, hyperglycemia Antithymocyte Globulin hypersensitivity reactions, intravenous administration Immune suppression
Oprelvekin - Recombinant IL-11	FDA approved for CIT	Excessive toxicity - flu like symptoms hypersensitivity reactions, fluid retention, cardiac arrhythmias
rHuTPO and PEG-rHuMGDF	Activity in CIT and MDS that led to development of second generation TPO agonists	Potential for development of neutralizing antibodies to endogenous thrombopoietin Discontinued from trials
Romiplostim	FDA approved for chronic ITP, once weekly dosing, non-immunogenic Ongoing clinical trials	Subcutaneous administration, potential for thromboembolic events and bone marrow fibrosis Not indicated for MDS and CIT
Eltrombobag	FDA approved for chronic ITP, oral formulation, non-immunogenic Ongoing clinical trials	Potential for thromboembolic events and bone marrow fibrosis Not indicated for MDS and CIT

CIT: chemotherapy-induced thrombocytopenia; ITP: Immune thrombocytopenia; MDS: myelodysplastic syndrome; rHuTPO: recombinant human thrombopoietin; PEG-rHuMGDF: pegylated recombinant human megakaryocyte growth and development factor; FDA: Food and Drug Administration