Comparison of Thrombopoietin Receptor Agonists Plus Recombinant Human Thrombopoietin versus Recombinant Human Thrombopoietin Alone for Hematopoietic Reconstruction in Multiple Myeloma Patients Undergoing Autologous Hematopoietic Stem Cell Transplantation

Background: Hetrombopag is a novel thrombopoietin receptor agonist that has shown an additive effect in stimulating platelet production when combined with recombinant human thrombopoietin (rhTPO). However, it remains unclear whether this combination can promote hematopoietic reconstruction after autologous stem cell transplant (ASCT). Purpose: To compare the effect of rhTPO plus thrombopoietin receptor agonists (TPO-RA) versus rhTPO alone on hematopoietic recovery, adverse events, postoperative complications, and cost-effectiveness in patients with newly diagnosed multiple myeloma (NDMM) undergoing ASCT. Methods: A total of 67 consecutive NDMM patients who underwent ASCT at our hospital from January 2021 to May 2024 were included. Of these patients, 35 received a combination of rhTPO and the TPO-RA hetrombopag after stem cell reinfusion (observation group), whereas 32 patients received rhTPO alone (control group). Hematopoietic reconstitution between the two groups was compared. Results: Baseline clinical characteristics were similar between both groups. In the observation group, the median time to platelet recovery was 9 days after stem cell reinfusion, which was significantly shorter than that in the control group (P = .003). The mean number of platelet transfusions in the observation group was significantly lower than that in the control group (1.0 vs. 2.0 units, P = .034). All patients tolerated rhTPO and TPO-RA well, with no thrombotic events observed. Survival analysis showed no reduction in time to progression (TTP) and overall survival (OS) with the addition of TPO-RA. There were no statistical differences in the incidence of adverse events, drug expenses, and hospital stay between two groups (P > 0.05). Conclusions: Although sample size and study design limit the data from this study, our findings suggest that the combination of TPO-RA (hetrombopag) and rhTPO enhances platelet recovery in comparison with rhTPO alone, without increasing adverse effects.