Update of guidelines for the diagnosis and treatment of thrombocytopenia caused by tumor therapy 2022 CSCO guidelines

From April 23rd to 24th, the 2022 Chinese Society of Clinical Oncology (CSCO) Guidelines Conference was successfully held in a combination of online and offline methods
.

At the meeting, Professor Zhao Donglu from the Harbin Institute of Hematology and Oncology gave a detailed and wonderful explanation on the update points of the "Guidelines for the Diagnosis and Treatment of Thrombocytopenia Induced by Tumor Treatment" (2022 Edition)
.

The main contents are organized as follows
.

Overview of CTIT With the continuous progress of science and technology and the continuous improvement of medical level, the treatment of tumors has been widely used in clinical practice from traditional radiotherapy and chemotherapy to targeted therapy and immunotherapy.
Diagnosis and treatment guidelines for different tumors are included
.

Professor Zhao Donglu introduced that, like traditional radiotherapy and chemotherapy, new treatment methods can also cause thrombocytopenia
.

Tumor therapy-induced thrombocytopenia (CTIT) is specifically defined as thrombocytopenia caused by anti-tumor therapy in tumor patients during the course of disease treatment, including chemotherapy-induced thrombocytopenia commonly seen in the past, as well as radiotherapy, targeted therapy, and chemotherapy.
Thrombocytopenia due to therapy and immunotherapy
.

Next, Professor Zhao Donglu introduced CTIT diagnostic principles, treatment principles, secondary prevention, precautions, prognosis and outcome
.

CTIT diagnostic principles CTIT diagnostic criteria, grading, and differential diagnosis are shown in the figure below
.

Principles of CTIT Treatment Next, Professor Zhao Donglu introduced the application of platelet growth factor, as shown in the figure below
.

Later, Professor Zhao Donglu said that the TPO-RA drugs currently listed in China, including Eltrombopag, Avatrombopag, Hytrombopag, and Roprostim, have not yet been approved for CIT indications
.

However, previous research data still showed the therapeutic potential of TPO-RA drugs in CIT
.

The efficacy of platelet transfusion is comparable to other cytokines in increasing platelet count, reducing platelet recovery time, reducing bleeding risk and platelet transfusion
.

Therefore, corresponding recommendations are also made in the new version of the guidelines, hoping to bring more treatment options to patients
.

CTIT Secondary Prevention CTIT Precautions For patients who need surgery, platelet transfusion or platelet growth factor should be used as needed to increase platelets to the required level
.

If the platelet count is between 75×109/L and 100×109/L and there is no bleeding, the use of rhTPO and/or rhlL-11 should be considered to increase the platelet count to meet the surgical requirements
.

For tumor patients with VTE or high risk of VTE, during the CTIT treatment, the platelet count should be closely monitored, and the "Chinese Expert Guidelines for the Prevention and Treatment of Tumor-Associated Venous Thromboembolism (2020 Edition)" should be referred to for relevant information.
prevention or treatment
.

CTIT prognosis and outcome For the treatment of CTIT, in the case of standardized platelet transfusion, the platelet-raising factor rhTPO, rhlL-11 or TPO-RA can also be used to treat and prevent CTIT
.

It can reduce the degree of thrombocytopenia caused by anti-tumor therapy, shorten the duration of thrombocytopenia, increase the minimum value of thrombocytopenia, reduce platelet transfusion, and ensure that chemotherapy is carried out as scheduled
.

Professor Zhao Donglu Assistant Director of Harbin Institute of Hematology and Oncology Hematology Ward 4 (Lymphatic System Diseases) Director Deputy Secretary General of the Committee Member of the Childhood and Adolescent Lymphoma Group of the CSCO Anti-Lymphoma Alliance Member of the CSCO Youth Expert Committee Member of the Chinese Anti-Cancer Association Hematology and Tumor Professional Committee Youth Member of the Chinese Geriatrics Society Hematology Branch Malignant Lymphoma Group Member of the Chinese Medical Association Hematology Committee members of the lymphoma group of the branch: Quinta typesetting: Quinta implementation: Youshi pokes "read the original text", we will make progress together