From the Guidelines
The initial treatment for hyper eosinophilia typically involves the immediate institution of oral or high-dose intravenous corticosteroids, as clinically indicated, especially in patients with suspected eosinophil-mediated cardiac damage/heart failure. This approach is supported by the National Comprehensive Cancer Network (NCCN) clinical practice guidelines in oncology, version 3.2021, which emphasizes the importance of prompt corticosteroid therapy in patients with myeloid/lymphoid neoplasms with eosinophilia and TK fusion genes 1.
Key Considerations
- Patients should be evaluated and managed by a multi-disciplinary team in specialized centers to assess for clinical situations that may require urgent intervention.
- Consultation with an infectious disease specialist is recommended as clinically indicated for the management of infectious disease-related complications.
- The use of corticosteroids aims to reduce eosinophil counts and prevent further organ damage, highlighting the need for close monitoring of clinical response and eosinophil count.
Treatment Approach
- Oral corticosteroids may be initiated at a dose that is clinically appropriate, with the goal of suppressing eosinophil production and reducing inflammation.
- High-dose intravenous corticosteroids may be necessary in patients with severe organ involvement or those who are critically ill, as indicated by the NCCN guidelines 1.
- Regular monitoring for treatment response and potential corticosteroid side effects is crucial to ensure optimal patient outcomes.
From the Research
Initial Treatment for Hyper Eosinophilia
The initial treatment for hyper eosinophilia depends on the underlying cause and severity of the condition.
- For patients with lymphocyte-variant hypereosinophilia and idiopathic hypereosinophilic syndrome (HES), corticosteroids are considered first-line therapy 2, 3.
- Hydroxyurea and interferon-α have also demonstrated efficacy as initial treatment and in steroid-refractory cases of HES 2, 4, 3.
- In cases where rearranged PDGFRA or PDGFRB is identified, imatinib is the preferred treatment due to its high responsiveness 2, 3.
- For patients with milder forms of eosinophilia without symptoms or signs of organ involvement, a watch and wait approach with close follow-up may be undertaken 2, 3.
Treatment Options
Other treatment options for hyper eosinophilia include:
- Mepolizumab, an interleukin-5 (IL-5) antagonist monoclonal antibody, which was recently approved by the US Food and Drug Administration for patients with idiopathic HES 3.
- Benralizumab, an IL-5 receptor antibody, as well as other targeted therapies such as JAK2 and FGFR1 inhibitors, which are under active investigation 3.
- Hydroxyurea and interferon-α, which have been used for decades to control eosinophilia and its clinical consequences 4.