{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T03:20:49Z","timestamp":1789701649483,"version":"4.0.1"},"reference-count":19,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T00:00:00Z","timestamp":1767657600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100002429","name":"Amgen","doi-asserted-by":"publisher","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/100002429","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Intensive chemotherapy is the cornerstone of lymphoma treatment but often leads to severe chemotherapy-induced thrombocytopenia (sCIT), resulting in treatment delays, reduced dose intensity, and the need for transfusions. While granulocyte colony-stimulating factors (G-CSFs) are commonly used to manage neutropenia, the use of thrombopoietic growth factors has not been adequately studied. Methods: This phase I dose-finding study evaluated the use of weekly romiplostim as prophylaxis for recurrent sCIT in patients undergoing chemotherapy for lymphoma. Eligible patients were those treated with a 21-day chemotherapy cycle who previously experienced sCIT, thus serving as their own \u201ccontrols\u201d. sCIT was defined as one of the following: (A) a platelet count (PLT) &lt;50 \u00d7 109\/L on day 1 of the subsequent cycle, leading to delay or dose reduction in chemotherapy, or (B) grade 4 thrombocytopenia (&lt;25 \u00d7 109\/L) and\/or (C) platelet transfusion for bleeding. The primary endpoints were the incidence of sCIT and the rate of romiplostim-associated-adverse-events, with thromboembolic complications being an event of special interest. Results: Nine patients with sCIT requiring a PLT transfusion on the prior treatment cycle were treated across three dose schedules. The phase 2 recommended schedule was defined as a starting dose of 3\u20135 mcg\/kg based on the baseline PLT count, with weekly adjustments for counts &lt;150 \u00d7 109\/L and &gt;450 \u00d7 109\/L. Romiplostim prevented recurrent grade 4 thrombocytopenia in 47% of the chemotherapy cycles and averted recurrent transfusion in 65% of cycles. Notably, low starting doses, as used in solid malignancies, were insufficient, leading to recurrent thrombocytopenia. Conclusions: Romiplostim was well-tolerated, with no thromboembolic events, and allowed most patients to complete their chemotherapy on schedule at full dose intensity.<\/jats:p>","DOI":"10.3390\/cancers18020188","type":"journal-article","created":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T15:09:36Z","timestamp":1767712176000},"page":"188","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Romiplostim for Prevention of Severe Chemotherapy-Induced Thrombocytopenia in Lymphoma Patients\u2014Phase I Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7883-289X","authenticated-orcid":false,"given":"Erel","family":"Joffe","sequence":"first","affiliation":[{"name":"Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA"},{"name":"Faculty of Medicine, Hematology, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary","family":"Epstein-Peterson","sequence":"additional","affiliation":[{"name":"Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA"},{"name":"Weill Cornell Medical College, New York, NY 10065, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1531-3838","authenticated-orcid":false,"given":"Lorenzo","family":"Falchi","sequence":"additional","affiliation":[{"name":"Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA"},{"name":"Weill Cornell Medical College, New York, NY 10065, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariela","family":"Noy","sequence":"additional","affiliation":[{"name":"Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA"},{"name":"Weill Cornell Medical College, New York, NY 10065, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1403-6883","authenticated-orcid":false,"given":"Andrew D.","family":"Zelenetz","sequence":"additional","affiliation":[{"name":"Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA"},{"name":"Weill Cornell Medical College, New York, NY 10065, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Collette","family":"Owens","sequence":"additional","affiliation":[{"name":"Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leah","family":"Gilbert","sequence":"additional","affiliation":[{"name":"Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9541-8666","authenticated-orcid":false,"given":"Gilles","family":"Salles","sequence":"additional","affiliation":[{"name":"Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA"},{"name":"Weill Cornell Medical College, New York, NY 10065, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8781-903X","authenticated-orcid":false,"given":"Gerald A.","family":"Soff","sequence":"additional","affiliation":[{"name":"Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL 33136, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/S0140-6736(24)01315-1","article-title":"Assessing the efficacy and tolerability of PET-guided BrECADD versus eBEACOPP in advanced-stage, classical Hodgkin lymphoma (HD21): A randomised, multicentre, parallel, open-label, phase 3 trial","volume":"404","author":"Borchmann","year":"2024","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2293","DOI":"10.1016\/S0140-6736(24)00184-3","article-title":"Ibrutinib combined with immunochemotherapy with or without autologous stem-cell transplantation versus immunochemotherapy and autologous stem-cell transplantation in previously untreated patients with mantle cell lymphoma (TRIANGLE): A three-arm, randomised, open-label, phase 3 superiority trial of the European Mantle Cell Lymphoma Network","volume":"403","author":"Dreyling","year":"2024","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"4184","DOI":"10.1200\/JCO.2010.28.1618","article-title":"Salvage Regimens with Autologous Transplantation for Relapsed Large B-Cell Lymphoma in the Rituximab Era","volume":"28","author":"Gisselbrecht","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3278","DOI":"10.1182\/blood.2021014488","article-title":"Fixed-duration ibrutinib plus venetoclax for first-line treatment of CLL: Primary analysis of the CAPTIVATE FD cohort","volume":"139","author":"Tam","year":"2022","journal-title":"Blood"},{"key":"ref_5","first-page":"2460","article-title":"How I treat cytopenias after CAR T-cell therapy","volume":"141","author":"Jain","year":"2023","journal-title":"Blood"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2892","DOI":"10.1200\/JCO.18.01931","article-title":"Romiplostim Treatment of Chemotherapy-Induced Thrombocytopenia","volume":"37","author":"Soff","year":"2019","journal-title":"J. Clin. Oncol."},{"key":"ref_7","first-page":"1148","article-title":"A multicenter study of romiplostim for chemotherapy-induced thrombocytopenia in solid tumors and hematologic malignancies","volume":"106","author":"Parnes","year":"2021","journal-title":"Haematologica"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"436","DOI":"10.6004\/jnccn.2022.0026","article-title":"NCCN Guidelines\u00ae Insights: Hematopoietic Growth Factors, Version 1.2022","volume":"20","author":"Griffiths","year":"2022","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3776","DOI":"10.1200\/JCO.1999.17.12.3776","article-title":"Ifosfamide, carboplatin, and etoposide: A highly effective cytoreduction and peripheral-blood progenitor-cell mobilization regimen for transplant-eligible patients with non-Hodgkin\u2019s lymphoma","volume":"17","author":"Moskowitz","year":"1999","journal-title":"J. Clin. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1080\/10428190801993470","article-title":"Salvage chemotherapy with rituximab DHAP for relapsed non-Hodgkin lymphoma: A phase II trial in the North Central Cancer Treatment Group","volume":"49","author":"Witzig","year":"2008","journal-title":"Leuk. Lymphoma"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1842","DOI":"10.1093\/annonc\/mdm341","article-title":"Maintaining the dose intensity of ICE chemotherapy with a thrombopoietic agent, PEG-rHuMGDF, may confer a survival advantage in relapsed and refractory aggressive non-Hodgkin lymphoma","volume":"18","author":"Moskowitz","year":"2007","journal-title":"Ann. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3241","DOI":"10.1182\/blood.V98.12.3241","article-title":"Thrombocytopenia caused by the development of antibodies to thrombopoietin","volume":"98","author":"Li","year":"2001","journal-title":"Blood"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1046\/j.1365-2141.2003.04450.x","article-title":"Impact of granulocyte colony-stimulating factor (CSF) and granulocyte-macrophage CSF in patients with malignant lymphoma: A systematic review","volume":"122","author":"Bohlius","year":"2003","journal-title":"Br. J. Haematol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3970","DOI":"10.1182\/blood-2023-179702","article-title":"Efficacy of Hetrombopag in Treatment of Cancer Therapy-Induced Thrombocytopenia in Lymphoma and Multiple Myeloma Patients","volume":"142","author":"Huang","year":"2023","journal-title":"Blood"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"17588359241260985","DOI":"10.1177\/17588359241260985","article-title":"Hetrombopag for the management of chemotherapy-induced thrombocytopenia in patients with advanced solid tumors: A multicenter, randomized, double-blind, placebo-controlled, phase II study","volume":"16","author":"Qin","year":"2024","journal-title":"Ther. Adv. Med. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2644","DOI":"10.1182\/blood.V74.8.2644.2644","article-title":"Hematologic Effects of Recombinant Human Granulocyte Colony-Stimulating Factor in Patients with Malignancy","volume":"74","author":"Lindemann","year":"1989","journal-title":"Blood"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2248","DOI":"10.1182\/blood-2008-03-145128","article-title":"A prospective clinicopathologic study of dose-modified CODOX-M\/IVAC in patients with sporadic Burkitt lymphoma defined using cytogenetic and immunophenotypic criteria (MRC\/NCRI LY10 trial)","volume":"112","author":"Mead","year":"2008","journal-title":"Blood"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e15","DOI":"10.1016\/S2352-3026(16)30185-5","article-title":"Rituximab, bendamustine, and low-dose cytarabine as induction therapy in elderly patients with mantle cell lymphoma: A multicentre, phase 2 trial from Fondazione Italiana Linfomi","volume":"4","author":"Visco","year":"2017","journal-title":"Lancet Haematol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3490","DOI":"10.1200\/JCO.2013.53.9593","article-title":"Randomized comparison of gemcitabine, dexamethasone, and cisplatin versus dexamethasone, cytarabine, and cisplatin chemotherapy before autologous stem-cell transplantation for relapsed and refractory aggressive lymphomas: NCIC-CTG LY.12","volume":"32","author":"Crump","year":"2014","journal-title":"J. Clin. Oncol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/2\/188\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T05:21:59Z","timestamp":1767849719000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/2\/188"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,6]]},"references-count":19,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["cancers18020188"],"URL":"https:\/\/doi.org\/10.3390\/cancers18020188","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,6]]}}}