Romiplostim is indicated for
immune thrombocytopenia (
ITP), though is often used off-label for other indications such as
chemotherapy-induced
thrombocytopenia (
CIT) and
thrombocytopenia post
hematopoietic stem cell transplantation (HSCT). Although
romiplostim is FDA approved at a starting dose of 1 mcg/kg, it is often initiated at 2-4 mcg/kg depending on the severity of
thrombocytopenia in clinical practice. Given the limited data, but interest in higher doses of
romiplostim for indications other than
ITP, we aimed to assess our inpatient
romiplostim utilization at NYU Langone Health.This was a single-center, retrospective review of 84 adult patients from January 2019 to July 2021. The top three indications were
ITP (51, 60.7%),
CIT (13, 15.5%), and HSCT (10, 11.9%). The median initial
romiplostim dose was 3.8 mcg/kg (range, 0.9-10.8). 51% of patients achieved a platelet count of ≥50 × 109/L by the end of week 1 of
therapy. For patients achieving goal platelets by the end of week 1, the median dose of
romiplostim was 2.4 mcg/kg (range, 0.9-10.8). There was 1 episode of
thrombosis and 1 episode of
stroke.We found that higher than FDA-recommended initial doses should be considered to achieve a platelet response. It appears to be safe to initiate
romiplostim as higher doses, and to increase doses by greater increments than 1 mcg/kg in order to achieve a platelet response. Future prospective studies are needed to confirm the safety and efficacy of
romiplostim in off-label indications and should evaluate clinical outcomes such as
bleeding and need for transfusions.