“Hypereosinophilic syndrome is a disease characterized by the presence of hypereosinophilia, i.e. a value of eosinophils”, a type of white blood cell of the immune system, “in the blood above 1,500, and by organ damage mediated by these eosinophilic granulocytes The diagnosis is complex as the “disease” involves multiple organs which can manifest itself through characteristic symptoms caused by the inflammation of that organ, but it can also occur asymptomatically. The diagnosis is also difficult as there are many pathologies associated with an increase in eosinophil count without therefore being able to be defined as hypereosinophilic syndrome”. Thus Luisa Brussino, director of Scdu Immunology and Allergology of the Ao Mauriziano of Turin, on the sidelines of the 'Ready to Hes' event which was held in the Piedmontese capital with the aim of differentiating and correctly classifying the pathology, proposing a first orientation document and offering a model of multidisciplinary methodological approach for the collection of clinical experiences at a national level, also given the availability of a new drug, a monoclonal antibody.
“The diagnosis involves examining organ involvement even in the absence of characteristic symptoms affecting that organ”, continued the expert. “For example – he explained – cardiac involvement can occur asymptomatically for a few weeks, therefore it should be looked for in all patients with hypereosinophilia even in the absence of symptoms. It is therefore a diagnosis of exclusion that requires time and attention, from on one hand to define the cause of hypereosinophilia and on the other to define the extent of organ involvement. For this reason it is essential to create multidisciplinary teams that collaborate for a correct diagnostic and management approach to this disease At the moment there are no PDTAs”, diagnostic-therapeutic care plans, “validated for the management of hypereosinophilic syndrome, but it is hoped that they can be achieved in a short time”.
When it comes to hypereosinophilic syndrome, “the hematologist also plays a key role – observed Cristina Papayannidis, medical director of the Irccs Aou Seràgnoli Institute of Hematology in Bologna – First of all, from a diagnostic point of view, the hematologist must go to exclude, first of all, clonal bone marrow pathologies caused by the presence of rearrangements or genomic alterations that determine an abnormal proliferation of eosinophils”, using “diagnostic tests with advanced molecular biology technologies”.
When this pathology is excluded, added Papayannidis, “all the other specialists, sooner or later, have already, or are already carrying out their therapeutic process, to try to understand the cause linked to eosinophilia. Where there is no if no cause is found and all the secondary factors that can induce this type of alteration are excluded, we will talk about idiopathic forms, for which today we have available – and it is a great step forward for our scientific community – a new drug, a monoclonal antibody that acts against interleukin 5 which is the factor that determines the growth of eosinophils”.
This drug, mepolizumab, “has the ability to modify and improve the symptoms that these patients may present, consequently improving their quality of life – highlighted the hematologist – They are often elderly patients, but also young, whose quality of life can be compromised by significant organ symptoms. Thanks to this therapeutic approach, great progress has also been made from this point of view”.
“Mepolizumab – concluded Brussino – is certainly a very useful drug, especially in order to reduce steroid therapy and avoid the chronic nature of the steroid therapy itself”.
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