Immunosuppresive agents

The use of hydroxyurea may be less effective in managing T-cell-mediated HES than other types of HES. T-cell-mediated HES is characterized by the expansion of immunophenotypically abnormal T cells (CD3+, CD4 ,

CD8 , or CD3", CD4+) and, in some cases, by a clonal rearrangement of the T-cell receptor genes.8182 Development of T-cell lymphoma and Sezary syndrome in this group of HES patients indicated the neoplastic potential of such T cells.82 These T-cells have a helper type 1 or 2 cytokine profile, and secretion of eosinophil production-stimulating factors may be a pathogenetic mechanism underlying the "lymphocytic" variant of HES.83 Some patients respond well to treatment with T-cell suppressive agents, such as cyclosporin A95,96 or cladribine in combination with steroids.97

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