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rhTPO + hetrombopag + cyclosporine is a triple combination therapy regimen being investigated by Peking Union Medical College Hospital for the treatment of transfusion-dependent non-severe aplastic anemia (TD-NSAA). This regimen combines two distinct thrombopoietin receptor agonists (TPO-RAs) with an immunosuppressant to synergistically stimulate bone marrow function and address the immune-mediated pathogenesis of the disease. Recombinant human thrombopoietin (rhTPO), a glycosylated biologic produced by Shenyang Sansheng Pharmaceutical, mimics endogenous TPO to stimulate megakaryocytopoiesis. Hetrombopag, developed by Jiangsu Hengrui Medicine, is an oral small-molecule TPO-RA that binds to the transmembrane domain of the TPO receptor (MPL). Cyclosporine A is a calcineurin inhibitor that suppresses the T-cell-mediated autoimmune destruction of hematopoietic stem cells. The combination is currently being evaluated in a Phase 4 clinical trial to determine if the addition of rhTPO to the standard hetrombopag and cyclosporine dual therapy improves early hematologic response and reduces transfusion dependency in patients with non-severe aplastic anemia.
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