Thrombocytopenia is very common in patients with hematological malignancies, either as a consequence of the underlying disease or the treatment. Most patients with bone marrow failure will receive platelet transfusions, and the ready availability of platelet concentrates over many decades has undoubtedly made a contribution to the supportive management of thrombocytopenic bleeding in these patients. Bleeding is also commonly documented in patients with hematological malignancies, although the types and severity of bleeding episodes may vary between studies, reflecting in part the challenges of recording bleeding using a standardised methodology. This session will explore current approaches to the management of thrombocytopenia in patients with haematological malignancies, focusing on our understanding on the role and effectiveness of platelet transfusions and the newer thrombopoietin analogues.

Dr. Simon Stanworth will discuss current views on the optimal use of prophylactic platelet transfusions for the prevention of haemorrhage in patients following the recent publication of two randomized controlled trials comparing a prophylactic versus no-prophylaxis policy of platelet transfusions in adults with thrombocytopenia due to hematological malignancies or therapy. Both clinical trials were attempting to address a more fundamental issue of the size of benefit of administering prophylactic transfusions of platelets, and both found a no-prophylaxis strategy led to higher rates of World Health Organization (WHO) Grade 2-4 bleeding overall. But both trials raised questions about the effectiveness of prophylactic platelet transfusions in subgroups of patients and specifically those undergoing autologous hemopoietic stem cell transplantation. All clinical trials of platelet transfusions have established a high ‘burden’ of bleeding despite prophylaxis, indicating that factors other than those addressed by prophylactic platelet transfusions are important in determining bleeding risk.

Dr. Aristoteles Giagounidis will discuss the available evidence for the use of thrombopoietin (TPO) receptor agonists romiplostim and eltrombopag in the treatment of both lower-risk and higher-risk MDS. The main focus will be attempts to increase platelet counts in MDS patietns with TPO-receptor agonists as monotherapy, but the benefit of combination treatment approaches will also be discussed.