Abstract
Low endogenous erythropoietin levels and limited red blood cell transfusion history can predict response to erythropoiesis-stimulating agents in anaemic patients with myelodysplastic syndromes (MDS). The relationship between endogenous thrombopoietin (THPO) levels and platelet response to romiplostim is unknown. Variables including baseline endogenous THPO levels, transfusion needs, and platelet response were analysed in a randomized trial of 250 thrombocytopenic, lower-risk MDS patients (International Prognostic Scoring System low/intermediate-1). A predictive scoring system was developed based on log-likelihood ratios and logistic coefficients. Patients with HI-P (haematological improvement - platelets) responses had lower mean baseline THPO levels (P=00497) and were more likely to have <6 platelet units transfused in the past year (P=00027), as did patients with platelet responses 50% of weeks on romiplostim (P=0001 and P=00037, respectively). A model for predicting response to romiplostim was developed and validated in a separate MDS cohort (N=72). Patients in low-, intermediate-, and high-response groups had response rates of 174%, 296%, and 507%, respectively, for HI-P, and 174%, 338%, and 652%, respectively, for 50% response. For thrombocytopenic patients with lower-risk MDS, lower baseline THPO levels (<500pg/ml) and limited platelet transfusion history predicted a greater likelihood of a subsequent platelet response to romiplostim.
