Dr. Pemmaraju on a New Era of Treatment Strategies in BPDCN

Naveen Pemmaraju, MD, associate professor in the Department of Leukemia of the Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center, discusses current treatment strategies in blastic plasmacytoid dendritic cell neoplasm (BPDCN).

BPDCN is its own entity. Clinically, it borrows from acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), and a little bit of lymphoma and melanoma, according to Pemmaraju. Before the modern era, locally-directed therapies, such as skin-directed therapies, surgeries, or radiation, were being used. These treatments were considered suboptimal, as they were not systemic therapies, says Pemmaraju.

The field of BPDCN has since entered a new era, adds Pemmaraju. Chemotherapy is an option, and it was available before targeted therapies were developed in this space, Pemmaraju explains. The regimen of hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone that has been used in ALL is another very effective regimen, according to Pemmaraju. Additionally, SL-401 (tagraxofusp) has also shown promise, eliciting a 90% overall response rate with a 72% complete response rate in the frontline setting, Pemmaraju adds. Other treatments include the new CD123 drugs such as IMGN632 and the BCL-2 inhibitor venetoclax (Venclexta).

All these approaches have been investigated in BPDCN and are not based on data from AML or other disease types, says Pemmaraju. These are some of the promising options that have emerged in the paradigm and are the focus of active investigation and combination approaches are also being explored, concludes Pemmaraju.