Eosinophilia

Question 1

Initial treatment of hyperoeosinophilia patients that are sick

Answer 1

High dose steroids

Question 2

Gene rearrangements in myeloid/lymphoid neoplasms associated with eosinophilia

Answer 2

• PDGFRA, PDGFRB,
• FGFR1, PCM1-JAK2,
• FLT3
• ETV6-ABL1 fusion

Question 3

Chronic eosinophilic leukemia clinical features

Answer 3

Persistent eosinophilia >1.5 x 10^9/L
No evidence of disease defining fusion proteins or molecular markers (ie- BCR-ABL, PDGFR etc) or >10% of WBCs
Abnormal BM morphology
Presence of a clonal marker (cytogenetic or molecular) and if no mutation, other etiologies excluded
>2% PB blasts or >5% marrow blasts but <20%
peak incidence 4th decade
Symptomatic - fever, fatigue, cough, pruritus, diarrhea, angioedema, myalgia, and end-organ damage

Question 4

General goal of treatment in CEl and HUS

Answer 4

Goal is to decrease eosinophil count to mitigate organ damage and prevent thrombosis

Question 5

Initial treatment of HES

Answer 5

prednisone 1 mg/kg
taper slowly to lowest effective dose
IF remission, maintain on prednisone 10 mg or lower indefinitely

Question 6

Other therapies for HES

Answer 6

Hydroxyurea as steroid sparing agent
Anti-IL-5 therapy (mepolizumab), anti-IL-5 receptor (benralizumab)
IFNalpha (also an option)

Question 7

Mepolizumab mechanism

Answer 7

Anti-IL5

Question 8

benralizumab mechanism

Answer 8

Anti-IL5

Question 9

IF hypereosinophilic condition associated with PDGFRA, what is the treatment?

Answer 9

Imatinib

Question 10

Significance of FGFR1 with myeloid neoplasms with hypereosinophilia

Answer 10

• aggressive, high rate of transformation to AML or T-ALL

Question 11

Pemigatinib SE”s

Answer 11

• hyperphosphatemia
• alopecia
• diarrhea
• stomatitis
• anemia