Nplate - risk for increased blasts

[Birgitta-A]

Hi All,
Another warning about the risk for increased blast cells due to treatment with Nplate for low platelets: http://www.mhra.gov.uk/home/groups/p.../con131855.pdf
Kind regards
Birgitta-A

[Sally C]

Hi Birgitta,
I know you have had reservations about drugs that increase platelets due to their side effects. Do you think this warning would apply to Promacta as well? As you are aware my husband has been on Promacta since March and is taking 150 mg/day in a clinical trial - twice the dosage that SmithKline recommends. However, right now we are a week into a 2 week trip to see his family that he hasn't seen since spring of 2008 due to his MDS. This is a result of taking Promacta and being able to go that long without platelet transfusions. His red cells have also been holding in the 9 range. I also want to add that he is feeling better than at any time since his diagnosis.
I know you are always direct with your answers and I would expect you to be with this one as well.
Thanks as always for your willingness to share your vast knowledge with Marrowforums.
I hope you are doing well.
Best wishes,
Sally

[Neil Cuadra]

The warning is a strong statement that Nplate should not be given to MDS patients because of an increased risk of transition to AML, especially for the higher risk MDS categories. It was also a warning about the risk of increased blasts if Nplate is given to MDS patients, after a study found that 4 times as many MDS patients had increased blasts as a placebo group.

To quote:

A positive benefit/risk for Nplate is only established for the treatment of thrombocytopenia associated with chronic immune (idiopathic) thrombocytopenic purpura (ITP), Nplate must not be used in other clinical conditions associated with thrombocytopenia.

The diagnosis of MDS must be excluded.

[Sally C]

Hi Neil,
I will ask you the same question that I asked Birgitta. Do you think this warning should apply to Promacta as well?
Thank you again for this forum and your always thoughtful answers.
Best wishes,
Sally

[Birgitta-A]

Hi Sally,
You know we don't know if Promacta increases blast cells in MDS patients because for some reason they are very late with reports about Promacta for us . Perhaps they will show a report at the Hematologic Conference ASH in Dec.

We know that both drugs can increase fibrosis of the bone marrow in patients with the autoimmune bleeding disease Immune Thrombocytopenuc Purpura.

There are several members of this forum who are taking Promacta or Nplate and have good responses.

Of cause your husband should continue to take Promacta.

I am still OK after 16 months with Thalidomide + Prednisone, thank you .
Kind regards
Birgitta-A
72 yo, dx MDS Interm-1 2006, supportive therapy including txs, chelating drugs and Neupogen until June 2010 when I started to take Thalidomide + Prednisone. Latest counts HGB 13.5, WBCs 4.4 and Platelets 92.

[Neil Cuadra]

Originally Posted by Sally C

Hi Neil,
I will ask you the same question...

Sally,

As Birgitta says, we don't know.

[Sally C]

Birgitta and Neil,
Thank you both for your replies. We can only hope for the best. With these drugs - sometimes you have to pick your poison. But so far so good.
Take care,
Sally