Eltrombopag with or without Tacrolimus for relapsed/refractory acquired aplastic anaemia: a prospective randomized trial

This trial compared eltrombopag (EPAG)+tacrolimus and EPAG monotherapy in patients with refractory/relapsed acquired aplastic anaemia (AA). Patients with refractory/relapsed AA were randomly assigned to receive either EPAG+tacrolimus or EPAG monotherapy at a ratio of 2:1. Patient response, safety, clonal evolution and survival were compared. In total, 114 patients were included in the analysis, with 76 patients receiving EPAG+tacrolimus and 38 receiving EPAG only. With a median follow-up of 18 (6–24) months, the overall response rate (ORR) for patients treated with EPAG+tacrolimus and EPAG alone was 38.2% vs . 31.6% ( P = 0.490) at the 3 rd month, 61.8% vs . 39.5% ( P = 0.024) at the 6 th month, 64.5% vs . 47.1% ( P = 0.097) at the 12 th month, and 60.5% vs . 34.2% ( P = 0.008) at the last follow-up. The rate of each adverse event, overall survival curves ( P = 0.635) and clonal evolution rate ( P = 1.000) were comparable between the groups. A post hoc subgroup analysis showed that EPAG+tacrolimus could have advantage over EPAG monotherapy in terms of the ORR at the 6 th month ( P = 0.030)/last follow-up ( P = 0.013) and the cumulative relapse-free survival (RFS) curves ( P = 0.048) in patients <60 years old.