Written in Blood
the excellent prognosis and indolent
course of NLPHL, event numbers
were insufficient to conclusively
compare specific treatments,” the
authors cautioned.
During the follow-up, the authors
observed 24 disease transformations
and secondary cancers in the entire
cohort, which occurred at a median
of 7 years (range = 0.4-15.6 years)
and 7.8 years (range = 1.1-24.8 years)
following diagnosis. This included
two transformations (5.4%) and
two secondary cancers (5.4%) in the
active surveillance group, compared
with 10 (7.9%) and 10 (7.9%) across
other treatment groups (p value
not reported). Overall, the rates of
transformation and secondary can-
cers were less than 1% per year, per
patient. However, the authors noted
that follow-up was possibly too short
to truly capture the incidence of
secondary cancers.
Higher Dose, Longer Duration of Eltrombopag Improves
Likelihood of Response in Refractory Severe Aplastic Anemia
The thrombopoietin receptor agonist
eltrombopag was approved by the U.S.
Food and Drug Administration for the
treatment of adults with refractory severe
aplastic anemia (rSAA) based on re-
sponse data at 12 to 16 weeks, but a study
published in Blood suggests that many
patients need treatment for at least 24
weeks to achieve a response.
“Our original study that was used to
support the current drug label for rSAA
employed a slow dose escalation, from
50 mg/day to 150 mg/day, due to lack
of experience at that time with doses
above 75 mg/day,” lead author Cynthia
Dunbar, MD, of the Translational Stem
Cell Biology Branch at the National
Heart, Lung, and Blood Institute told
ASH Clinical News. “Given the lack of
toxicity of 150 mg/day in our initial
trial and multiple subsequent ongoing
The First and Only Treatment for
Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN)
FROM A DEADLY DISEASE
RISES A DURABLE RESPONSE
This rare form
of Hodgkin
lymphoma has
an excellent
prognosis,
regardless
of treatment
strategy.
Other limitations of the study in-
clude its retrospective design, its in-
clusion of patients from only MSKCC,
the lack of a random treatment
allocation, and the shorter follow-up
in patients with active surveillance
versus any other treatment.
Further collaborative efforts may
provide definitive answers about which
subgroups of patients with NLPHL can
be safely managed with active surveil-
lance, but the authors concluded, “In
the absence of randomized trials, it
might be advisable to approach NLPHL
in selected patients (e.g., those without
risk factors for progression such as
bulky or extranodal disease) in a similar
fashion to indolent NHL.”
The authors report no conflicts of
interest.
REFERENCE
Borchmann S, Joffe E, Moskowitz CH, et al. Active surveillance for
nodular lymphocyte-predominant Hodgkin lymphoma. Blood.
2019 February 15. [Epub ahead of print]
INDICATION
• ELZONRIS is a CD123-directed cytotoxin for the treatment of
blastic plasmacytoid dendritic cell neoplasm (BPDCN) in adults
and in pediatric patients 2 years and older
IMPORTANT SAFETY INFORMATION
Boxed WARNING: CAPILLARY LEAK SYNDROME
• Capillary Leak Syndrome (CLS), which may be life-threatening or
fatal, can occur in patients receiving ELZONRIS. Monitor for signs
and symptoms of CLS and take actions as recommended
WARNINGS AND PRECAUTIONS
Capillary Leak Syndrome
• ELZONRIS can cause capillary leak syndrome (CLS), which may
be life-threatening or fatal if not properly managed. The overall
incidence of CLS in clinical trials was 55% in patients receiving
ELZONRIS, including 46% in Grades 1 or 2, 6% in Grade 3,
1% in Grade 4, and 2 fatal events. Common signs and
symptoms (incidence ≥ 20%) associated with CLS that were
reported during treatment with ELZONRIS include
hypoalbuminemia, edema, weight gain, and hypotension
• Before initiating therapy with ELZONRIS, ensure that the patient
has adequate cardiac function and serum albumin is ≥ 3.2 g/dL
• During treatment with ELZONRIS, ensure that serum albumin
levels are ≥ 3.5 g/dL and have not been reduced by ≥ 0.5 g/dL
from the albumin value measured prior to dosing initiation of
the current cycle. Monitor serum albumin levels prior to the
initiation of each dose or more often as indicated clinically
thereafter. Additionally, assess patients for other signs or
symptoms of CLS, including weight gain, new onset or
worsening edema including pulmonary edema, hypotension,
or hemodynamic instability
• Counsel patients to seek immediate medical attention should
signs or symptoms of CLS occur at any time
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ASH Clinical News