For patients with symptomatic HES and evidence of end-organ damage or clinical symptoms, such as cough, dyspnea, myalgia, or neurologic deficits, the first treatment of choice is the daily administration of systemic corticosteroids (1 mg/kg). In most cases, this treatment results in a rapid reduction of eosinophilia, organ infiltration with eosinophils, suppression of the inflammatory process, and prevention of further organ damage. Whether such treatment ameliorates existing organ damage is uncertain.88-91 In patients positive for FLIP1-PDGFRa, imatinib mesylate would be an alternative and probably preferable treatment. Documentation of clonal HES (FLIPl-PDGFRa, abnormal karyotype), CEL, or clonal hematologic disorder with eosinophilia on the diagnostic sample or on a subsequent follow-up examination would require reconsideration of this approach plus additional agents or change of therapy.

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