Eosinophilia medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Overview
- Medical treatment for eosinophilia should be directed at the underlying cause (for example treating parasitic infection or malignancy).
- Eosinophilia without evidence of organ dysfunction may be observed with monitoring for evidence of organ involvement.
- Treatment of hypereosinophilic syndrome has a number of options including corticosteroids, hydroxyurea, interferon-alpha, imatinib and other tyrosine kinase inhibitors, IL-5 antibodies, and other cytotoxic and immunomodulatory agents.
Medical Therapy for Hypereosinophilia Syndromes
- Corticosteroids are most commonly used as first line therapy. They are able to produce a rapid decrease in eosinophil counts, which is valuable if there is already evidence of organ dysfunction related to high eosinophil levels. [1]
- 0.5-1mg/kg/day of prednisone (or the equivalent dose of another steroids) is the recommended starting dose. Patients with non-severe disease manifestations can start with lower doses [1]
- Steroids are tapered over time, with second line agents added if needed to maintain control.
- In one study, corticosteroids were able to induce remission in 85% of patients at 1 month [2]
- Hydroxyurea is the most commonly used second-line agent for hypereosinophilic syndrome. Typical dose range is 500mg-2g per day. Hydroxyurea acts at the level of the bone marrow to reduce production of new eosinophilis. [1] As such it is not suitable if a rapid lowering in eosinophil levels is needed. Hydroxyurea is not usually used alone, it is most often used as an additional steroid-sparing agents.
- Interferon-alpha is also a second-line, steroid sparing agent. Use of this agent is limited by its toxicities. Interferon-alpha also has activity on lymphocytes, so it may be particularly effective in eosinophilia secondary to lymphocytic malignancies. [1]
- Imatinib and related TKIs have shown promise in treating chronic eosinophilic leukemia due to similar molecular re-arrangements as CML. [1][3] This family of TKIs is very well tolerated. These drugs are most effective in patients who have the FIP1L1-PDGFRA rearrangement driving a clonal expansion in the bone marrow. [2]
- Anti-IL5 antibody mepolizumab has shown potential to rapidly reduce eosinophil counts in trials and reduce the need for corticosteroids, however this agent is still investigational. [4]
- Other cytotoxic agents have been used in isolated cases, but lack strong evidence
- In severe cases refractory to other therapy, stem cell transplant may be considered if the cause of the eosinophilia is a primary bone marrow process.