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This is a nice reminder that immune checkpoint inhibitors (ICI)-associated immune thrombocytopenia (ITP) is uncommon but definitely not benign~1 in 400 incidence with a meaningful subset recurring on rechallenge of 30%, and while most patients recover, severity clearly tracks with worse outcomes including higher mortality. It reinforces that even “rare” hematologic irAEs can carry real clinical weight, so early recognition and thoughtful decisions around rechallenge are key.

This is the first phase 3 data we’ve had for chemotherapy-induced thrombocytopenia, and romiplostim really moved the needle, 84% of patients were able to avoid CIT-driven dose reductions or delays versus just 36% with placebo, with a risk ratio of 2.8. Platelet nadirs were higher, responses were faster (median ≈1 week), and relative dose intensity was meaningfully better maintained across cycles. Bleeding wasn’t significantly different, but events were numerically lower, and this study wasn’t powered for that. Toxicity was largely chemo-related, with a small signal for thromboembolism (2%), so overall this feels like a practical tool to help maintain dose intensity in gastrointestinal tract (GI) cancers getting oxaliplatin-based regimens.

This NEJM study challenges the long-held view that heparin-induced thrombocytopenia (HIT) is a polyclonal antibody disorder. Using mass spectrometry and immunofixation, the investigators found that all 9 patients with HIT had monoclonal, platelet-activating anti–PF4–heparin antibodies, with 67% showing a detectable M-protein by immunofixation. Functional assays confirmed that only the monoclonal fraction was pathogenic. It looks like HIT is driven by a single rogue antibody clone, which could have big implications for diagnostics and targeted therapy—this would be a paradigm shift for how we think about this disease.

Eltrombopag improved platelet count and decreased bleeding , was safe, but did not affect progression to AML or survival. May consider in severe thrombocytopenia to help improve quality of life.