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Stemline Therapeutics Inc (STML)
Q4Â 2019 Earnings Call
Mar 16, 2020, 8:00 a.m. ET
Contents:
- Prepared Remarks
- Questions and Answers
- Call Participants
Prepared Remarks:
Operator
Good day, and welcome to the Stemline Earnings Conference Call. [Operator Instructions]
At this time, I would like to turn the conference over to Ken Hoberman. Sir, please go ahead.
Ken Hoberman -- Chief Operating Officer
Good morning, and thank you for joining us during these trying circumstances. Welcome to today's conference call to discuss our fourth quarter 2019 financial results. With me on today's call are members of management team including Ivan Bergstein, our Chief Executive Officer; David Gionco, our Chief Accounting Officer and Robert Francomano, our Chief Commercial Officer. After our prepared remarks, we will open the call to take your questions.
As a reminder, we may be making forward-looking statements. Our forward-looking statements are subject to a number of risks and uncertainties that could cause our actual results to differ materially from our forecasts. A detailed description of these risks can be found in the forward-looking statements in Risk Factors section of our annual report on Form 10-K for the year ended December 31, 2019 and in our quarterly report on Form 10-Q for the quarter ended September 30, 2019.
With that, I will now turn over the call to Ivan Bergstein, our CEO. Ivan, the floor is yours.
Ivan Bergstein -- Chief Executive Officer and President
Thank you, Ken, and good morning, everyone. And I hope and trust everyone is doing their utmost to keep yourselves, your families, your friends, colleagues and communities as safe as possible in this unprecedented time of uncertainty. With these big issues facing us all, it almost seems trivial to have this call. But as P.T. Barnum was famous for saying, the show must go on.
And with that, let me distract us for a brief moment from a serious macro issues at hand to remind you that 2019 was a tremendous year for Stemline as we launched ELZONRIS, the first CD123 targeted agent ever approved. With ELZONRIS on the market and generating revenue, coupled with our strong balance sheet, we have built a strong foundation from which to grow as a company. This includes aggressively pursuing growth opportunities for ELZONRIS, both within and beyond BPDCN, including expanding the potential utility of ELZONRIS in additional CD123 positive indications. And we look forward to trial updates and data readouts in indications including CMML, chronic myelomonocytic leukemia; MF, myelofibrosis and AML, acute myeloid leukemia including in CD123 enriched population later this year and on into next year.
Ultimately, we see ELZONRIS as a potentially global product that has multiple approved indications, including a positive target phase label. And in parallel, we continue to advance our pipeline of additional agents, namely our novel and differentiated XPO1 inhibitor, SL-801 currently in Phase 1 trials of advanced solid tumor patients and our RET inhibitor, SL-1001 currently slotted to enter Phase 1 trial next year. Overall, we believe that with this multi-pronged approach and solid balance sheet, we are setting ourselves up for the potential for significant growth and success.
With that, I will now turn the call over to Robert Francomano, our Chief Commercial Officer, who will provide details on the launch and overall commercial prospects. Robert?
Robert M. Francomano -- Chief Commercial Officer
Thank you, Ivan. In the fourth quarter, net sales of ELZONRIS totaled $11.8 million contributing to the full year 2019 net revenue of $43.2 million. We are pleased with the solid uptick seen in the first year of ELZONRIS commercial launch, but are set squarely focused on continuing to successfully create, grow and penetrate this new BPDCN U.S. market.
Building upon the launch initiatives we enacted last year, we have instituted a number of new strategies and tactics that focus our efforts in two key areas. First, we are laser-focused on increasing brand uptake among the correctly diagnosed BPDCN patients. And second, to substantially improve disease diagnosis skill sets in the market, while reducing misdiagnosis rates. Together, we expect to further expand the BPDCN market.
Going into more detail on the first bucket, further penetrating the correctly diagnosed patient segment, we are implementing three new initiatives. First is the enhancement of patient targeting and identification efforts. With the leveraging of the most recent claims data, we expect to identify patients earlier in their journey, which will lead to improved efficiency and deployment of our field force and resource.
Second is to expand prescriber base via targeted and precise customer engagement. With the utilization of new data, we can judiciously engage not only the most influential targets phase to phase, but expand our reach into new market segments. This will lead to an increased efficacy of our field force. Third, and one that we are very excited about is to expand treatment rates with ELZONRIS in the community setting. In new partnerships with oncology networks and group purchasing organizations, we believe the community market segment will be receptive to further diagnosing and treating BPDCN patients that in the past may have been referred elsewhere. An attractive byproduct of this expansion will be the reduction of our 340b discount exposure, which should enhance net revenue.
Shifting to the second growth bucket, substantially improving disease diagnosis skill sets in the market while reducing misdiagnosis rates, we will first implement a new focus on diagnostic labs to increase diagnostic proclivity and diagnosis rate. This should yield reduced misdiagnosis, while keeping BPDCN and CD123 top of mind. Our efforts will further enhanced or be enhanced with enacting of lab alerts, pathologists, clinical annotations and tailored disease state education.
Second, and starting within the next few weeks, we will rollout a diagnostic sales team. This new and highly experienced team will mainly target diagnostic labs across the U.S. and allow us to more broadly interact with a very important healthcare practitioner. We firmly expect this to advance CD123 testing and BPDCN awareness.
Lastly for this bucket is to more deeply study the BPDCN patient journey via new claims data analysis. The latest claims data will allow us to better characterize market and patient demographics in the misdiagnosis segment. As you would expect, this will also aid in further penetrating the BPDCN observed population. We expect this to lead to improved early diagnosis and transition more BPDCN diagnosed patients to ELZONRIS starts, of course within label. We fully expect that these new strategies and tactics will start to benefit the growth trajectory later this year and into the foreseeable future.
Shifting to other key data points that we disclosed earlier this month, IQVIA recently conducted an analysis of the 2018 medical claims data that was very supportive of our previously reported estimates of the U.S. market size based on disease incidents. In it, IQVIA found 534 unique patients that had at least one medical claim consisting of the blastic NK-cell lymphoma diagnosis are specifically referring to the ICD-10 diagnostic code of C86.4. As many of you know, blastic NK-cell lymphoma is the former name of BPDCN.
There are few important takeaways from this data. First, this number could represent an annual minimum incidents given the data capture rate is only about 30% to 50% of all medical claims. Additionally, this number does not include the in-patient setting, misdiagnosed or undiagnosed patients. We believe this data set paves the way for a deeper understanding of this burgeoning market, including patient journey, presentation manner, geography, diagnosis and treatment patterns. All of these combined initiatives which I just touched on are likely to help inform a market approach to more optimally penetrate the BPDCN market.
Beyond the U.S., we are looking forward to potential commercialization in Europe where we continue to build the appropriate corporate infrastructure in preparation of a possible approval in the second half of 2020. On March 5, we met with the European Medicines Agency's Scientific Advisory Group to discuss the tagraxofusp clinical data in patients with BPDCN. Aspects of benefit risk such as safety and efficacy, as well as other elements pertaining to the marketing authorization application procedure were discussed. We had a productive meeting and look forward to receiving the final meeting minutes.
Overall, we are pleased with ELZONRIS uptake in 2019, but note that much work remains to be done. Our commercial and medical affairs teams are well positioned and prepared to execute on all of these new initiatives. This approach reflects our commitment to helping BPDCN patients receive a rapid and correct diagnosis, and ultimately, obtain the best treatment for their disease. Again, we see ourselves in a marathon, the one that we believe we are well equipped to win.
At this time, I would like to turn the call over to Stemline's, Chief Accounting Officer, David Gionco. David?
David Gionco -- Senior Vice President of Finance and Chief Accounting Officer
Thank you, Robert. Our fourth quarter results can be found in the press release that we issued on Friday evening, which I will summarize. Stemline ended the fourth quarter with $164.4 million in cash, cash equivalents and short-term investments, reflecting net cash expenditures of $10.1 million during the quarter. Research and development expenses were $10.5 million for the fourth quarter of 2019, which reflects a decrease of $1.6 million compared with $12.1 million for the fourth quarter of 2018. The lower expenses are primarily attributable to higher costs incurred during the fourth quarter of 2018 related to the ELZONRIS BLA filing and manufacturing of ELZONRIS prior to FDA approval.
Selling, general and administrative expenses were $16.5 million for the fourth quarter of 2019, which reflects an increase of $1.6 million compared with $14.9 million for the fourth quarter of 2018. The increase in costs were primarily attributable to ongoing U.S. launch expenses for ELZONRIS and pre-launch ELZONRIS-related costs in support of a potential regulatory approval and launch in the European Union. The company ended the fourth quarter of 2019 with 50.3 million shares outstanding.
I will now turn the call back to Ivan Bergstein, our CEO for concluding remarks. Ivan?
Ivan Bergstein -- Chief Executive Officer and President
Thank you, David. Again, we remain very pleased with the continued progress Stemline is making both in the market and with our ongoing efforts to expand ELZONRIS' potential utility both within and beyond BPDCN, as well as with the progress we have made with our overall pipeline, and we're looking forward to building upon the strong foundation moving forward.
Here at Stemline, we are driven by mission to help improve the lives of patients with cancer. I would like to take this opportunity to thank all the patients, physicians, healthcare professionals and all the outstanding employees of Stemline, your dedication and passion in making a difference in patient lives. And again, recognizing the unprecedented macro events we are now all facing with coronavirus and uncertain market, we at Stemline wish you all healthy peace. We are all in this together. Let me remind you that we have all chosen healthcare as our profession, not by accident, but because we all share the common goal of bettering the mankind. And it is our industry, which all of us play an integral role, which will lead the way to conquering this global pandemic.
With that, I'd like to open the call to questions.
Questions and Answers:
Operator
Thank you, sir. [Operator Instructions] Our first question will come from Jessica Fye with J.P. Morgan.
Jess Fye -- J.P. Morgan -- Analyst
Guys, good morning. Thanks for taking my question. Just a couple. I think for the third quarter you provided the quarter-over-quarter growth in new patient starts. Can you provide that for the fourth quarter? And second one is, with the diagnostic sales team expect to rollout in the coming weeks, how many individuals will that include? And should we anticipate any disruption to the planned rollout in light of the outbreak mitigation efforts? Thanks.
Ivan Bergstein -- Chief Executive Officer and President
Robert, do you want to take those?
Robert M. Francomano -- Chief Commercial Officer
Yes, certainly. Good morning, Jess. Indeed, what you saw for the fourth quarter based -- think about what we did in the third quarter based on than what we saw in the fourth quarter, there was roughly about a 30% or 33% decrease in new patient starts. So that should answer that question. As far as the diagnostic sales liaisons rollout, I think it's safe to say that what is going to happen in the foreseeable future could indeed have some sort of impact.
With the starting of this new liaison team and going through training and targeting, a lot of that work in the beginning is busy work. You're studying and preparing strategies and plans. So depending on how long this -- the COVID or coronavirus situation entails, it could potentially affect that rollout. But what we do have in place is our complete strategies for advancing business needs to the best of our abilities, while minimizing face-to-face interactions. The approach that we are taking is 100% in line and consistent with industry norms.
Jess Fye -- J.P. Morgan -- Analyst
Great. Thank you.
Robert M. Francomano -- Chief Commercial Officer
You're welcome.
Operator
Thank you. Our next question comes from Boris Peaker with Cowen.
Boris Peaker -- Cowen and Company -- Analyst
Good morning. I just want to probe a little bit further on the new patient start you mentioned in 4Q versus 3Q. Can you comment exactly what was driving those dynamics?
Ivan Bergstein -- Chief Executive Officer and President
As far as the 30% or 33% reduction in patient starts or other dynamics, Boris?
Boris Peaker -- Cowen and Company -- Analyst
Yeah, that's what I meant. Decline in patient starts, yeah.
Ivan Bergstein -- Chief Executive Officer and President
Yeah. I think it's pretty much the consistent story that we've related in the past that what we see is in this disease state, certainly with the small end that we're finding is that the patients are presenting or getting diagnosed and transitioning to ELZONRIS starts with really no rhyme or reasons that traditional choppiness that we've characterized quite well over the past many, many months. So I think it's just a byproduct of that.
So we firmly believe and continually -- the data we receive supports the premise that the patients are going to present per our wishes if you will or the basis on the number of the incident population. But we look back and see their presentation rate on a yearly basis rather than the quarter-on-quarter. So when I zoom back and look at 2019, we are very happy with the number of patients we were able to transition to an ELZONRIS start are less concerned honestly with quarter-to-quarter dynamics.
Boris Peaker -- Cowen and Company -- Analyst
Got you. Just another question on that. My last question. In terms of patient treatment, what fraction of actual BPDCN patient end up being treated by their diagnosing physicians or on what fraction do the physician actually send it to somebody else and essentially lose the patient?
Ivan Bergstein -- Chief Executive Officer and President
Yeah. I don't have all of the answers of that, I can give you some thoughts on what we are assuming based on data. First and foremost, I had mentioned in the prepared comments that we are in the process of conducting a patient journey, research piece that will look at the claims data and give us more precise insights into that question. So what I -- my standard answer there is that will be kind of wait for us to report on that when we see those results.
Honestly we don't know how many. It's just -- if you look at the history of the disease, it makes a very strong argument that many of these patients which are coming through the derm, to the derm-path channel are misdiagnosed first and foremost. And then if they are lucky enough to get a correct diagnosis, they're being seen by heme-onc and then diagnosed and then treated. That probably is the lion's share of the patients. I can't give you an exact number on how that happens, but that's -- there is still a significant amount of misdiagnosis and under diagnosis.
We've done a great job improving that over the last year with the efforts of Stemline and then even prior to that with our disease awareness. The IQVIA data, if you compare that versus the SEER database from a couple of years ago, you can clearly see a growth in the diagnosis of this disease. We certainly feel that that's at the hand of our work since nobody else is really focusing on this disease state the way we are. But at this point, until we get some further clarity on these other analyses of the recent claims data, I can't tell you precise numbers, Boris.
Boris Peaker -- Cowen and Company -- Analyst
Great. Thank you very much for taking my questions.
Ivan Bergstein -- Chief Executive Officer and President
Thank you.
Operator
Thank you. Our next question will come from Matt Kaplan with Ladenburg Thalmann.
Matthew Kaplan -- Ladenburg Thalmann & Co. Inc. -- Analyst
Hi. Good morning, guys. Just wanted to dig in a little bit more to the IQVIA data, I guess in terms of -- you indicated really the 534 patients with the code of C86.4 diagnosis that could represent an annual minimum. What's your thinking now in terms of what the kind of more accurate number is now in the U.S. and potentially in Europe from this study that IQVIA completed?
Ivan Bergstein -- Chief Executive Officer and President
Yeah, Matt. I think we're going to stick with the same numbers that we've been saying consistently that -- and we feel that the U.S. market is a minimum of 500, but could certainly be north of that. What we really need to do is -- and so we're going to stick with that number right now, which I think as everybody knows, is certainly a very good opportunity for Stemline and for ELZONRIS, certainly given the price points.
As we look at the IQVIA data -- and once again I'll refer back to the greater analysis that we're undertaking. We would expect that if you look at the capture rates of the data and missed diagnosis and the patient journey that we seek to understand further is that this really could only be the tip of the iceberg. What we're more likely to understand then is the -- really the presentation and the diagnosis of the disease. Where we're seeing these patients most likely get misdiagnosis? Where are they misdiagnosis? what are they getting misdiagnosis -- misdiagnosed with? And then ultimately the ones that are correctly diagnosed with BPDCN, where are they presenting? And hopefully where are they getting treated? And all of these insights I believe are going to be pretty close at hand once this once these latest analysis bear fruit. But we'll have a pretty decent projection and understanding of that in short-term, but not quite yet ready to give any answers there.
Matthew Kaplan -- Ladenburg Thalmann & Co. Inc. -- Analyst
Okay. Fair enough. Thank you. And just on the diagnostics team, where will your initial focus be on the derm-path or heme-onc area? Where do you think the largest amount of missed diagnosis is occurring at this point?
Ivan Bergstein -- Chief Executive Officer and President
Yeah. Current data math shows that the largest amounts of work that needs to be done would be the dermatopathologist. Of course, that is not an indictment on their good work, just a byproduct of the workflow if you will. So we would expect that the targeting, which will of course use metrics and data that we have, will focus on both the dermatopathologist, the hematopathologist, and as necessary, the general pathologists. But we'll focus on those pathologists, mostly in those labs that are seeing the bulk of these tissue samples. The diagnostic sales liaison can then follow the bread crumbs, if you will, and go to outside sources or other laboratories based on the needs of the business. But in short answer, yes, I would assume that most of the time is going to correct the misdiagnosis or helping increase the skill set with the dermatopathologist, but there still is an opportunity for the heme, the hemepath as well.
Matthew Kaplan -- Ladenburg Thalmann & Co. Inc. -- Analyst
Okay. And then last question, I guess maybe for Ivan. Can you give us an update in terms of how the CMML and MF programs are progressing and when we should expect some initial readout maybe from the 3a and when could we see a transition to the 3b in the CMML program?
Ivan Bergstein -- Chief Executive Officer and President
Yeah. So both of them recently opened. So they're opened for enrollment. So it's early days in terms of the next stages of these studies. We've said for a while that the 3a, 3b combined, Stage 3, we expect to be at two to three year endeavor that obviously can shift upwards if things pick up and we see signals earlier on, but we're thinking two to three years. So we may have some initial updates later this year, but probably more likely early next year on both programs.
Matthew Kaplan -- Ladenburg Thalmann & Co. Inc. -- Analyst
And then lastly, in terms of perhaps the program with respect to getting an overall CD123 class of diagnostic for across -- where are you in terms of interaction with the FDA on that?
Ivan Bergstein -- Chief Executive Officer and President
Yeah. So no formal interaction on that yet. We're going to pick the appropriate time to do that. But we are laying the groundwork for what we hope will be a very productive interaction. The groundwork being, we're implementing CD123 analysis on all of our studies, including CMML and MF, as well as AML. So within each study, we'll be looking at expression levels, as well as we're working on putting together an all commerce [Phonetic] study that's in the drafting stage that will also contribute to this body of knowledge and really put the story to get in nicely and expect to interact with the FDA probably some time later next year around this. But we think there is a strong basis for proceeding here. And as we've said before, it seems like the environment for the FDA thinking out of the box is definitely here.
Matthew Kaplan -- Ladenburg Thalmann & Co. Inc. -- Analyst
Great. Thanks a lot for taking the question, guys.
Operator
Thank you. [Operator Instructions] Our next question will come from Alethia Young with Cantor Fitzgerald.
Alethia Young -- Cantor Fitzgerald -- Analyst
Hey guys. Thanks for taking my question. One, can you talk a little bit about the timelines on the maintenance, BPDCN trial? And can we just talk a little bit more about kind of what you think could happen in the community? I guess, is it just a factor of finding these physicians or is it just really the fact that there are some other dynamics that we're not appreciating that is now a kind of a more important dynamic to consider once you've gotten probably lot of the KOLs? And then the third question, have you guys opined recently on what the diagnosis rate is in BPDCN? Thanks.
Ivan Bergstein -- Chief Executive Officer and President
Thanks. Robert. I'll take the first one. The maintenance study is opened for enrollment. It's slated to be a several year study. However, it's our intention to, given it's open label nature, to provide incremental updates around the study at appropriate times at various conferences over the next year or so. So it will be kind of a rolling update as that study proceeds. Robert, do you want to handle another question?
Robert M. Francomano -- Chief Commercial Officer
Yes. Looking at what we saw in 2019 and then trying to understand some of the latest medical claims data, it's hard to give an exact diagnosis rate, but I would tell you quite firmly, it's my position -- our position that the diagnosed -- the diagnosis rate is still quite low compared to what's out there, the success we saw in 2019 with the patients that we were able to get transition to ELZONRIS. I'll remind you that the launch, the go-to-market strategy and the launch of the brand was to focus of course on the NCC and NCI cancer centers as well as an additional 30 or 35 other type targeted cancer centers where a lot of the patients would be treated and typically diagnosed at, and of course, that's what we're going to continue to do. But as we move into the community, what that's going to do is get us into the area where there's probably a lot of misdiagnosis and under diagnosis and the need for even greater CD123 testing to get to those diagnoses.
So we feel really firmly that a lot of the patient starts last year were really due to the efforts of our field force and going out and really finding these patients, and that's what the market seems to respond to quite heavily is following the breadcrumbs and trying to put the pieces together and find potential patients that may be otherwise headed down a path of a different diagnosis and getting them to a BPDCN diagnosis. And we were successful at that with our existing structure.
If we move into the community setting, if you look at lab alerts, precision, analytics to get us to pockets of business in the community, we can get to the community in a very precise fashion, not only with the analytics and the lab alerts and analysis of data, but then also with the partnering with group purchasing organization. It allows us to get into a very targeted portion of that business to then start to build the -- that segment and that revenue stream for us and then take it further along the path there.
So we feel that the path forward is quite clear on how to get them, but until we see the market perform in a different way, we feel that we have to be very, very assertive in going and helping find the patients, and that's what we're prepared to do to support the revenue growth for 2020. Hey Alethia, did I miss any other...
Alethia Young -- Cantor Fitzgerald -- Analyst
It was just the diagnosis rate, but I think probably you kind of touched on it.
Robert M. Francomano -- Chief Commercial Officer
Yeah. I think it's -- I don't have a perfect number, but we have a lot of work to do there to improve that.
Alethia Young -- Cantor Fitzgerald -- Analyst
Yeah. Got it. Thank you.
Robert M. Francomano -- Chief Commercial Officer
You're welcome.
Operator
Thank you. Our next question comes from Joe Catanzaro with Piper Sandler.
Joseph Catanzaro -- Piper Jaffray -- Analyst
Hey guys. Thanks for taking the questions. Just two quick ones for me. So Robert, you mentioned that the choppiness in new patient starts that you observed over the last couple of quarters, is that something we should expect to continue into 2020? And then I just wanted to follow-up on the misdiagnosed patients, and it sounds like you're doing work to better understand this. But what is your current understanding of misdiagnosed patients in their treatment journey? What are they being diagnosed with? How are they being treated? And how do you get them on to ELZONRIS? Thanks.
Robert M. Francomano -- Chief Commercial Officer
Sure. The choppiness that we saw in 2019, we forecast the same type of choppiness in 2020 as well. Does that mean you will see the same pattern of choppiness in 2020 as we did in 2019? No. I think what we learn every day of our lives in this market is that the market just does not have any type of formal consistency as of yet. As we build a number of diagnosed cases in ELZONRIS starts, we believe that choppiness of course will attenuate. So the answer there is yes. We should -- I would expect the choppiness in 2020.
As far as the misdiagnosis and the journey, I'm sorry, can you just give me that question -- that aspect of the question one more time so I can make sure I give it -- a proper answer?
Joseph Catanzaro -- Piper Jaffray -- Analyst
Yeah, sure. So I guess -- again, it sounds like you guys are doing work to better understand this, but I guess as of now, what is your understanding of misdiagnosed patients and their treatment journey? What are they being diagnosed with? How are they being treated, etc.?
Robert M. Francomano -- Chief Commercial Officer
Okay. Yeah, the data that we have in hand and not only in our research analysis, but also talking with key opinion leaders and then also being in the market now for the past years is that it's still the same type of entities that we've disclosed in the past. AML, forms of AML not otherwise specified, perhaps leukemia, cutaneous lymphoma and then list can go on. But it's typically those types of disease entities.
And essentially what is happening is that of course in those situations, and I'll speak in general terms, those patients are typically then going to be treated with either a standard of care for whatever disease they are being treated for or sometimes depending on how, I guess far they are in their treatment whether or not responding they made sometimes even be transition to other treatment. So essentially, that's the answer. If somebody has a diagnosis that might be even more like an ALL, they might go and get an ALL treatment as well or if it's -- if there is a disease that has a lot of characteristics of a lymphoma, it might go to it's shop and things of that nature.
So I think it's pretty consistent with how the market and the physician pool typically treats the disease that they're getting misdiagnosed with. Of course if they can lead to a missed -- to a correct diagnosis, which does happen, we saw a lot of these misdiagnosed patients in the past, and I'm speaking anecdotally, we've seen a lot of patients in the past that were previously misdiagnosed and not responding to the treatment at hand go back because of our work patients would then get another sample taken as tissue sample test for CD123 which would lead among other things to BPDCN, other things meaning other biomarkers like CD4 and CD56. And of course in those situations, the best chance had a good response to treatments to get them to ELZONRIS. And so we have seen that happen as well.
Joseph Catanzaro -- Piper Jaffray -- Analyst
Okay, great. That's helpful. Thanks for taking my questions.
Robert M. Francomano -- Chief Commercial Officer
Thank you.
Operator
Thank you. Our next question comes from Yi Chen with H.C. Wainwright.
Yi Chen -- H.C. Wainwright & Co. Inc. -- Analyst
Thank you for taking my question. Could you comment on how many of those 534 patients identified in IQVIA are still receiving treatment and whether the patients who received ELZONRIS in 2019 overlap with any of those patients?
Ivan Bergstein -- Chief Executive Officer and President
Thank you. So I'll provide just a couple of more points of context around that IQVIA data. Keeping in mind it was 2018 full year data. Those 534 patients, of course, none of them would have received ELZONRIS because ELZONRIS was not approved at that point in time. Our analysis stopped there for that portion of the analysis. The patient journey research that I referenced a few times this morning will give us more precise answers to that.
So I would expect with the deadliness of the disease with treatment rates that many of those patients logically if they were either not on -- not correctly diagnosed in the beginning, likely had severe disease and may not have ever been treated for BPDCN with at that point in time just as standard treatments like hyper-CVAD or the like. So I have no way of knowing if any of those patients ever came on to ELZONRIS.
It would stand to reason that if you look at the approval, which came at the end of 2018 and we loaded the distribution channel at the end of January, there could quite possibly and likely could have been handful of patients that spans 2018 into 2019 and then likely would have come out to an ELZONRIS start possibly in the relapsed-refractory setting. That's speculative though at this point.
Yi Chen -- H.C. Wainwright & Co. Inc. -- Analyst
Thanks. And the second question is, of those patients who receive ELZONRIS in 2019, could you comment on what proportion of patients who started and discontinued in 2019 and what proportion started and continued treatment into 2020? Hello?
Ivan Bergstein -- Chief Executive Officer and President
I'm sorry. I had to take myself off. Once again, what we've stated in the past is while we do have a level of understanding of patient flow and journey on ELZONRIS, it's imprecise because our distribution channel and methodologies of getting product to patients doesn't allow us to fully understand the full picture of how patients are treated when and whatnot. So there is a lot of that is unknown to us. But what I would likely tell you is that these are deadly diseases and a lot of these patients, certainly the successful ones that are getting at the stem cell transplant are seeing maybe three, four, five or six cycles of ELZONRIS getting into a CR. And then if they're stem cell transplant eligible, they're going into -- and they're going into that. And then that patient comes off therapy.
So at this point, there is not -- we're dealing traditionally with an incident population rather than a prevalent population. Until we get the -- raise the level of proclivity with the product and we start to increase the survival rates, they will generally be a certain percentage of patients for instance that started treatment in 2019 that will both remain on treatment in 2020. So there will be a bridging of those two years. The exact number, it's hard to say. It all depends on how they're doing.
Yi Chen -- H.C. Wainwright & Co. Inc. -- Analyst
Last question is, when we talk about potential negative impact from the coronavirus outbreak, do you think the impact is going to be primarily on the identification of new patients or the ongoing treatment of existing patients?
Ivan Bergstein -- Chief Executive Officer and President
I would expect -- it's hard to say how this will impact the business anytime an organization like ours which thrives on face to face interactions as the industry. There is going to be some shift. So it's hard for me to say at this early stage what will happen. I would tell you that with the deadliness of this disease, if a patient is diagnosed with BPDCN, this is no less of a serious cause than say the coronavirus. So I would expect that all patients that are diagnosed with BPDCN that none of their treatments would be hampered. I find that hard to believe, although that's an opinion.
As far as the ID'ing patients, I think we're going to need to be very creative and diligent in doing that because I do believe we have a strong role. If we look at the site of misdiagnosis and what we can do to affect a change on that, a lot of that can happen in the virtual manner; with teleconferences, with web access, with virtual programs. In fact this past weekend, we had a speaker program that was to take place in Dallas with the heme-path, with the heme-onc, dermatologists and we shifted that program from a live event in Dallas to a virtual program, which was quite successful.
So we believe in our capability of transitioning these face to face interactions through other virtual methods and we're going to go very, very aggressively toward that to make sure that, to the best of our ability, we keep the we keep the diagnosis rate climbing and patient starts with ELZONRIS increasing.
Yi Chen -- H.C. Wainwright & Co. Inc. -- Analyst
Thank you.
Ivan Bergstein -- Chief Executive Officer and President
You're welcome.
Operator
Thank you. At this time, we have no further questions. I would now like to turn the call back over to Ivan Bergstein for closing remarks.
Ivan Bergstein -- Chief Executive Officer and President
Thank you, operator, and thank you all for joining us on the call this morning. Everybody stay safe.
Operator
[Operator Closing Remarks]
Duration: 40 minutes
Call participants:
Ken Hoberman -- Chief Operating Officer
Ivan Bergstein -- Chief Executive Officer and President
Robert M. Francomano -- Chief Commercial Officer
David Gionco -- Senior Vice President of Finance and Chief Accounting Officer
Jess Fye -- J.P. Morgan -- Analyst
Boris Peaker -- Cowen and Company -- Analyst
Matthew Kaplan -- Ladenburg Thalmann & Co. Inc. -- Analyst
Alethia Young -- Cantor Fitzgerald -- Analyst
Joseph Catanzaro -- Piper Jaffray -- Analyst
Yi Chen -- H.C. Wainwright & Co. Inc. -- Analyst
