ITP and facing chemo treatments

I was diagnosed with ITP in May of 2016. Platelet levels were 100K to 115K so well withing safe ranges. Was diagnosed with ovarian cancer in September, 2016. Had surgery and five chemo treatments, with each one a battle trying to get platelets up to 100K so they would allow a chemo treatment. #5 chemo treatment required 4 days of heavy duty steroids which got platelets up to 260K so they did the treatment and said that was the last treatment. At this point I am NED and hopeful I stay that way for awhile. Since ending chemo treatments in March, 2017, my platelets have been steady at around 87K.
My concern is, if I need to get additional cancer treatments, how to I handle the low platelet issue? My docs say not to worry about it yet, but I do and need to know there are some options out there so I can continue to find this cancer. If anyone has had similar experiences or possess info that might help, I would be extremely grateful.
Nancy

Nancy - You have two platelet problems going on. One is the ITP. The second is that chemo can cause platelet production and destruction from the drugs. That is not something that we can advise you on since it's out of the realm of ITP alone. Your doctors did a good job the last time so I'd trust them if it happens again. You seem to respond very well to steroids so that seems like a good option.

Good luck to you. I hope you don't have to go through that again.

Thanks, Sandi. Was looking to see if any other members had similar experiences.

We don't get too many cancer patients here. Sorry.

So, Sandi, you are telling me that this site and its members can be of no assistance to me?
I am sorry to trouble you. Perhaps you could suggest a better site for this inquiry?

You're not troubling us! Please do not feel that way. If you just had ITP as an issue, we could be of more help. Having chemo changes things and places you in a different category. There is no way to know if your ITP would be causing the low platelets or if it would be due to chemo-induced thrombocytopenia.

My mom had cancer in 1995 and while she was having chemo, her platelets dropped to below 10k many times. She did not have ITP and the count drop was solely due to the chemo. She was on high dose Prednisone for six months. I would have had no idea how to manage that or help her in any way. Her red cells and whites also dropped, but she got Neupogen and Aranesp for that. At that time, there were no drugs to boost platelets.

I'm not sure if this will help or not, but there are now two drugs that stimulate platelet production. They are N-Plate and Promacta. I'm pretty sure they are given to cancer patients at times. It seems as though Prednisone shot your counts up the last time so that might be your best option if it happens again. That is the most common ITP treatment also.

You are welcome here to read, observe and ask questions. I'm just saying that none of us have the expertise to advise a chemo patient of the best course of action. You can learn about the treatments and question your doctors if the time comes. Anyone is welcome here. When you are not undergoing chemo and counts drop, we can definitely try to help you with our knowledge and experiences.

Sandi, You are right about Nplate and Promacta being used to treat chemotherapy induced thrombocytopenia.
Example: www.ncbi.nlm.nih.gov/pubmed/24414994

Support Care Cancer. 2014 May;22(5):1217-22. doi: 10.1007/s00520-013-2074-2. Epub 2014 Jan 12.
Romiplostim for management of chemotherapy-induced thrombocytopenia.
Parameswaran R1, Lunning M, Mantha S, Devlin S, Hamilton A, Schwartz G, Soff G.
PURPOSE:
Chemotherapy-induced thrombocytopenia (CIT) can cause delay or reduction in subsequent courses of chemotherapy. Here, we report on a series of 20 patients who had protracted CIT and were treated with romiplostim, a thrombopoietin receptor agonist.
PATIENTS AND METHODS:
We performed a retrospective review of the use of romiplostim for dose-limiting CIT at Memorial Sloan-Kettering Cancer Center from 2010-2012. Romiplostim was initiated at 1-2 mcg/kg weekly, with dose escalation by 1 mcg/kg per week until recovery of platelets (≥ 100 × 10(9)/L). If patients resumed chemotherapy, weekly romiplostim was continued.
RESULTS:
Romiplostim improved platelet counts in all 20 patients. In 19 of 20 patients, platelet counts of ≥ 100 × 10(9)/L were achieved. The mean dose of romiplostim to achieve adequate platelet recovery was 2.9 mcg/kg (range 1.0-5.1). Sixteen patients achieved platelet recovery by 2 weeks. Fifteen patients resumed cytotoxic chemotherapy with continued romiplostim support and 14 tolerated at least two subsequent cycles of chemotherapy, on schedule, without recurrence of dose-limiting CIT. Sepsis prevented continued chemotherapy in one patient. No resistance to romiplostim was observed. Three deep vein thromboses (DVT) were observed; one of which was a recurrent DVT in a patient who had previously experienced a DVT and was off anticoagulation. Three DVTs within 20 patients is within the anticipated thrombosis rates of patients with active cancer on chemotherapy.
CONCLUSION:
Romiplostim resulted in improvement in platelet counts, allowing resumption of chemotherapy without recurrence of dose-limiting CIT. No treatment-related toxicity was observed, but this would need to be confirmed in a larger, prospective trial. Our series differs from prior studies in that we selected only those patients who had already demonstrated persistent thrombocytopenia, and we continued weekly romiplostim during chemotherapy. Romiplostim may be a safe and effective treatment for CIT.
PMID: 24414994 DOI: 10.1007/s00520-013-2074-2