Efficacy and Safety of Hetrombopag Versus Thrombopoietin in Promoting Platelet Engraftment After Allogeneic Hematopoietic Stem Cell Transplantation: A Prospective, Multicenter, Randomized Controlled Clinical Trial

作者：Yimei Feng, Linhui Wang, Mingqiang Ren, Dan Wang, Tao Lang, Jianchuan Deng, Shifeng Lou, Hai Yi, Liangliang Ma, Hongyun Xing, Pengcheng He, Xiaoning Wang, Sanbin Wang, Jishi Wang, Han Yao, Ting Chen, Jia Liu, Lu Zhao, Yuqing Liu, Xiaoqi Wang, Li Li, Shuhan Tang, Lidan Zhu, Jia Liu, Shichun Gao, Huanfeng Liu, Lu Wang, Peiyan Kong, Lei Gao, Xi Zhang · 发表于：American Journal of Hematology · 年份：2025 · DOI：10.1002/ajh.27746 · 被引用次数：6 · 研究领域：Platelet Disorders and Treatments、Multiple Myeloma Research and Treatments、Myeloproliferative Neoplasms: Diagnosis and Treatment

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is pivotal for hematological malignancies but faces challenges in delayed platelet engraftment, poor graft function (PGF), and bleeding risks. Hetrombopag, a thrombopoietin receptor agonist, was evaluated to enhance platelet recovery posttransplant. Patients undergoing allo-HSCT were randomized on Day 3 Post-Infusion into low-dose (2.5 mg/day), high-dose (5 mg/day) hetrombopag groups, or a control group receiving thrombopoietin (300 U/kg/day). Endpoints included platelet/neutrophil engraftment time, PGF incidence, transfusion needs, and safety. Among 212 analyzed patients, platelet engraftment was faster in hetrombopag groups (median 13 days) versus controls (15 days; p = 0.0022), with no dose-dependent difference (p = 0.0593). Neutrophil engraftment was also accelerated (13 vs. 15 days; p = 0.0001). PGF incidence was lower in hetrombopag groups (5.04%) versus controls (13.7%; p = 0.027). The experimental group required fewer platelet transfusions (p = 0.002), had reduced gastrointestinal bleeding, and lower costs. Secondary platelet recovery failure showed no intergroup differences. Hetrombopag safely accelerates platelet and neutrophil engraftment, reduces PGF risk, and decreases transfusion dependency post-allo-HSCT. Low-dose hetrombopag demonstrated efficacy equivalent to high-dose, offering a cost-effective strategy to improve transplant outcomes. Trial Registration: ChiCTR2200057764.