Eltrombopag stopped responding

[Bhsl]

Hello, I am suffering from ITP since 1 year. At the time of diagnosis, my platelet count was 3000 only. I am refractory to steroids, rituximab, pappaya extract. Tried azathioprine but count is not going above 40000. My hamatologist started Eltrombopag and my count raised to 1.5 lac. Since last three months count has been dropping to 1.3 lac, 80k,40k eventhough on Eltrombopag.

My haemoglobin was 14 initially now dropped to 12.4.

My hematologist advised to continue Eltrombopag and told me that he will do intervention when count dropped below 20000. He is also not interested to add other immunosuppressants as I have completed course of rituximab.

I have queries. Am I going towards bone marrow failure.? What are other reasons for lowering of response.? Is it a routine that Eltrombopag do not respond or respond less after some days? How to boost response to Eltrombopag without further immunosuppression?

[conquerator2]

It's not a cause for concern, I don't think, though it is necessary to rule out other causes. Meds stop working from time to time (refractory) but they can start having an effect again with increased dosage or simply trying something else for a while and coming back. Unless you've tried high doses of everything there's always more things to try