Retrospective Study of Romiplostim for Platelet Engraftment After Allo-HSCT

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an important curative treatment for various hematological malignancies and non-malignant hematological disorders. However, delayed platelet engraftment remains a frequent complication after transplantation and is associated with prolonged thrombocytopenia, increased bleeding risk, higher transfusion requirements, and extended hospitalization.

Romiplostim, a thrombopoietin receptor agonist (TPO-RA), promotes megakaryocyte proliferation, differentiation, and platelet production through activation of the thrombopoietin receptor (c-Mpl). Although romiplostim has been widely used in immune thrombocytopenia and chemotherapy-induced thrombocytopenia, its efficacy and safety in promoting platelet engraftment after allo-HSCT remain unclear.

The investigators retrospectively analyzed patients who underwent allo-HSCT at Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology between January 2025 to May 2026. Patients were categorized into a romiplostim group and a control group according to whether romiplostim was administered after transplantation.

To minimize baseline imbalance and potential confounding factors, propensity score matching (PSM) was performed at a 1:1 ratio.

The primary endpoint was time to platelet engraftment. Secondary endpoints included platelet recovery kinetics, transfusion requirements, transplant-related complications, and safety outcomes.

Kaplan-Meier analysis with log-rank testing and Cox proportional hazards regression models were performed to evaluate factors associated with platelet engraftment.

Inclusion criteria

• Patients diagnosed with AA, AL, MDS, PMF, or other hematologic diseases according to internationally accepted diagnostic criteria
• Patients who underwent allo-HSCT during the study period
• Patients with complete clinical characteristics, transplantation records, and follow-up data

Exclusion criteria

• Primary graft failure;
• Death before hematopoietic engraftment
• Missing key clinical data;(4) Use of thrombopoietin receptor agonists other than romiplostim

Inclusion criteria

• Patients diagnosed with AA, AL, MDS, PMF, or other hematologic diseases according to internationally accepted diagnostic criteria
• Patients who underwent allo-HSCT during the study period
• Patients with complete clinical characteristics, transplantation records, and follow-up data

Exclusion criteria

• Primary graft failure;
• Death before hematopoietic engraftment
• Missing key clinical data;(4) Use of thrombopoietin receptor agonists other than romiplostim