Foran Goes Beyond the Basics of BPDCN

In this episode of Targeted Talks, James M. Foran, MD, discusses the presentation and diagnosis of blastic plasmacytoid dendritic cell neoplasm (BPDCN).

Foran is a medical oncologist and professor of medicine at the Mayo Clinic based in Jacksonville, Florida, and chair of the acute leukemia and myeloid neoplasm disease group in the cancer center. He focuses on acute leukemia, supports the bone marrow transplant program, and works on clinical trials and novel agents for treating rare myeloid diseases.

The conversation starts with Foran explaining that BPDCN is a rare disease that can present as acute leukemia and is sometimes mistaken for acute myeloid leukemia or acute lymphoblastic leukemia. He emphasizes the importance of recognizing and characterizing skin lesions, as well as working with pathologists to identify CD123, CD4, and CD56 markers.

“What is important about the disease is that you can get extramedullary involvement, [and] you can get short-term responses to chemotherapy, but we seem to do better if we can guide [patients] to transplant more quickly. And, we have some targeted agents that are now FDA-approved and available for this group that seem to improve outcomes,” says Foran.

He continues the conversation by highlighting challenges in diagnosing BPDCN, including misdiagnosis and delayed diagnoses. He delves into how a multidisciplinary approach to treating BPDCN is crucial to offer the best outcomes to patients and discusses the importance of both tagraxofusp [Elzonris], a CD123-targeted immunotoxin, and allogeneic transplantation for long-term remission.

“I think the key is to have a discussion early on,” explains Foran. “The strength of induction therapy, whether it's tagraxofusp or even some of the chemotherapy regimens that have been used historically before that, is to get [patients] to transplant. I think that is really the only way to get long-term remission and possibly cure a patient with BPDCN.”