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Background: This study aimed to explore the effects of recombinant human thrombopoietin (rhTPO) on platelet recovery in decitabine, cytarabine, aclarubicin, and G-CSF (DCAG)-treated patients with intermediate-high-risk myelodysplastic syndrome/hypo proliferative acute myeloid leukemia.

Methods: Recruited patients were at a ratio of 1:1 into 2 groups: the rhTPO group (DCAG rhTPO) and control group (DCAG). The primary endpoint was the time for platelets to recover to >= 20 x 109/L. The secondary endpoints were the time for platelets to recover to >= 30 x 109/L and >= 50 x 109/L, overall survival (OS), and progression-free survival (PFS).

Results: The time required for platelet recovery to >= 20 x 109/L, >=30 x 109/L, and >= 50 x 109/L in the rhTPO group was significantly shorter (6.5 /- 2.2 vs 8.4 /- 3.1 days, 9.0 /- 2.7 vs 12.2 /- 3.9 days, 12.4 /- 4.7 vs 15.5 /- 9.3 days, respectively; all P < .05 vs controls). The amount of platelet transfusion in the rhTPO group was smaller (4.4 /- 3.1 vs 6.1 /- 4.0 U, P = .047 vs controls). The bleeding score was lower (P = .045 vs controls). The OS and PFS were significantly different (P = .009 and P = .004). The multivariable analysis showed that age, karyotype, and time for PLT recovery to >= 20 x 109/L were independently associated with OS. Adverse events were similar.

Conclusions: This study suggests that rhTPO leads to a faster platelet recovery after DCAG treatment, reduces the risk of bleeding, reduces the number of platelet transfusions, and prolongs the OS and PFS.

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