Avatrombopag Reduces Platelet Transfusion Requirement in Chemotherapy-Induced Thrombocytopenia: A Retrospective Cohort Study in Haematological Patients

Background: Chemotherapy induced thrombocytopenia (CIT) leads to bleeding complications, treatment delay or de intensification, and platelet transfusion requirement. Evidence suggests that thrombopoietin receptor agonists (TPO RAs) can restore platelet counts in this scenario. Avatrombopag (AVA) is an oral TPO RA whose efficacy in treating CIT in haematological malignancy has been barely addressed. Objectives: We aimed to evaluate AVA’s efficacy in improving platelet recovery and reducing transfusion requirement in haematological patients with CIT. Methods: In this retrospective observational study, haematological patients who developed CIT persisting for 3 weeks and were treated with AVA between November 2023 and December 2024 were recruited. Results: Twenty three patients were recruited. Nineteen (82.6%) responded to AVA, most within the first four weeks: ten (43.5%) and nine (39.1%) achieved platelet counts >30×109/L (partial response) and >100×109/L (complete response), respectively. Response was maintained after a median (interquartile range [IQR]) follow up of 47 (26–99) days from therapy initiation. Transfusions were significantly fewer than in the previous period: 0 (0–8) vs. 11 (2–15), p = 0.007. Once on treatment, 13 (56.5%) patients no longer required transfusion. No patient delayed or de intensified chemotherapy. No safety concerns were reported. Conclusions: AVA shows promise in safely reducing CIT associated transfusion needs in haematological malignancy.