Less transfusion in leukemia care, but no demonstrated survival gain

Blood products are a crucial part of aggressive leukemia treatment, and reducing transfusion requirements could matter to patients and oncology units. The EPAG-2015 trial tested whether eltrombopag, introduced after chemotherapy, might help older adults through the difficult period of low platelet counts.

Its central outcome was not improved: the study did not establish a survival benefit, and the hazard-ratio confidence interval was wide. The reduction of two median platelet transfusions is potentially useful but secondary. It should not be rhetorically promoted into a successful mortality trial.

The clinical question is therefore narrower and practical: could a safely timed platelet-support strategy ease care in a defined setting without compromising cancer treatment? This requires the full protocol, adverse-event tables, blood-product use and local transfusion practices.

The evidence: 110 adults aged 60 and older receiving induction chemotherapy for newly diagnosed acute myeloid leukemia in 18 French hospitals; 55 eltrombopag, 55 placebo; median follow-up among survivors 20.9 months. The prespecified overall-survival objective was not met (HR 1.59; 95% CI 0.65–3.89; P=0.31). Complete response or response with incomplete recovery occurred in 45 people in each group. Median platelet transfusions were 8 (IQR 6–14) versus 10 (7–14); no increase in grade 3–4 adverse events was reported.

on this evidence.