Eltrombopag for Refractory Immune Thrombocytopenia in a Patient with Chronic Lymphocytic Leukemia: A Case Report

We report a case of chronic lymphocytic leukemia associated immune thrombocytopenia (CLL-associated ITP) with suboptimal response to steroid responding to second line agent.

A 68-year-old female patient known to have diabetes mellitus and chronic lymphocytic leukemia (CLL) presented with spontaneous bruising on her body and around her right eye. Initial laboratory investigations reveal hemoglobin level of 10.6 g/dL, platelet count of 11 × 10⁹/L, white blood cell count of 50.0 × 10⁹/L with negative direct and indirect Coombs tests were negative. The patient has a suboptimal response and rapid platelet declines once prednisone is tapered off. Consequently, Eltrombopag was introduced at a daily dosage of 50 mg, resulting in a rapid and sustained response over two years, reaching a platelet count of 282 × 10⁹/L without requiring rescue treatment. Notably, steroids were tapered within the first three weeks of Eltrombopag administration, and aspirin was resumed once the platelet count reached 50 × 10⁹/L.

Eltrombopag represents an effective and safe treatment alternative for patients with CLL-associated ITP, particularly those diagnosed with diabetes mellitus. However, the potential risks of iron deficiency and Eltrombopag's food interactions prior to initiating therapy, during dose escalations, or when transitioning to alternative treatments are important considerations. Future studies with large number sample size along with identification of cytogenetic and molecular abnormalities are required to identify patient populations that may respond favorably to Eltrombopag without necessitating rescue therapies, chemotherapy, immunotherapy or CLL directed therapy.