Acute lymphocytic leukemia (ALL) associated with eosinophilia is a rare occurrence, but a distinct clinicopathological entity. There have been approximately 44 cases reported in the world literature to date. We report 2 previously healthy young men, aged 20 and 32 years, who presented with marked eosinophilia, and were later diagnosed with pre-B ALL. The patients suffered from significant complications related to eosinophil toxicity, including respiratory failure, myocardial infarction, and a cerebrovascular accident during initial hospitalization. They were treated with high-dose steroids resulting in a rapid suppression of the eosinophilia. Both patients also received chemotherapy according to the standard protocol for ALL; unfortunately, case 1 expired within 2 years of diagnosis from complications related to sepsis and multi-organ failure. We also review the literature and compare the demographics, clinical features, and outcomes of several case studies reported.
"The association of acute lymphoblastic leukaemia (ALL) and hypereosinophilia represents a distinct clinico-pathological entity [2-4], although rarely described in childhood [2,5,6], with 44 paediatric cases reported to date . In these patients, presenting symptoms are non-specific and include intermittent low-grade fever, fatigue and “purpuric” rash . Although hypereosinophilia has commonly been interpreted as a reactive epiphenomenon rather than the result of a leukemic clone , its occurrence appears to be associated with worse prognosis, both in children  and adults . "
[Show abstract][Hide abstract] ABSTRACT: Hypereosinophilia as first clinical presentation has rarely been reported in paediatric acute lymphoblastic leukaemia. It is commonly associated with specific cytogenetic abnormalities. Although eosinophilia is considered a reactive, non-neoplastic epiphenomenon, it adversely affects patient outcomes, both in children and adults. We describe herewith two paediatric patients who had marked eosinophilia at onset of acute lymphoblastic leukaemia. We point out the importance of a correct differential diagnosis in persistent, unexplained peripheral hypereosinophilia. Clinicians should keep in mind that eosinophilia can be part of the overall pattern of acute leukaemia and therefore needs to be properly investigated. We also provide some recommendations for an appropriate approach to hypereosinophilia - related morbidities.
Italian Journal of Pediatrics 04/2014; 40(1):36. DOI:10.1186/1824-7288-40-36 · 1.52 Impact Factor
"Eosinophilia in the peripheral blood smear of patients with pre-B cell leukemia has been reported more often than other types of leukemia . Most recently, Wilson et al.  reported 2 cases of pre-B cell ALL that initially presented with prolonged eosinophilia and respiratory distress. "
[Show abstract][Hide abstract] ABSTRACT: Patient: Male, 5 Primary Diagnosis: Rule-out appendicitis Co-existing Diseases: Acute lymphoblastic leukemia (ALL) Medication: Chemiotherapy Clinical Procedure: Chest CT • flow cytometry Specialty: Pediatrics' oncology • infection diseases.
Leukemias are among the most common childhood malignancies. Acute lymphoblastic leukemia (ALL) accounts for 77% of all leukemias. In rare cases, ALL patients may present with eosinophilia.
Here, a 5-year old boy was admitted to our hospital with a possible diagnosis of appendicitis. This patient's complete blood cell count demonstrated leukocytosis with severe eosinophilia. Following a 1-month clinical investigation, 2 bone marrow aspirations, and flow cytometry analysis, a diagnosis of acute lymphoblastic leukemia was proposed. Finally, the patient was transferred to the oncology ward to receive standard therapeutic protocol, which resulted in disease remission. After chemotherapy for 2 years, patient is successfully treated.
ALL is diagnosed by eosinophilia in rare cases. These patients need immediate diagnosis and intensive therapy due to worsened prognosis of ALL presenting as hypereosinophilia.
American Journal of Case Reports 05/2013; 14:143-6. DOI:10.12659/AJCR.883905
"The most common cytogenetic abnormality associated with this presentation is t(5;14)(q31;q32) resulting in an overproduction of IL-3; this entity has been recently recognized as a distinct subtype among B-cell ALL in the 2008 WHO classification . However, t(5;14)(q31;q32) translocation is only present in about 10% of cases of ALL with eosinophilia , and several case reports with the same clinical phenotype but lacking the rearrangement have been described    . The association between lymphoblastic lymphoma (LBL) and eosinophilia appears to be less common. "
[Show abstract][Hide abstract] ABSTRACT: Hypereosinophilia, either clonal or reactive, has been described in association with multiple hematological malignancies. We describe a case of a patient presenting with hypereosinophilia that evolved into T-cell lymphoblastic lymphoma. Complete remission was achieved with chemotherapy; however, hypereosinophilia recurred 5 months later in association with myeloblastic bone marrow infiltration and without evidence of lymphoblastic lymphoma relapse. Cytogenetic analysis of the bone marrow showed a complex translocation involving chromosomes 7, 12, and 16. A rearrangement of ETV6 gene (12p13) was demonstrated by FISH studies, thus confirming the clonality of this population. The association of lymphoblastic lymphoma, eosinophilia, and myeloid hyperplasia has been described in disorders with FGFR1 rearrangements. We hypothesize that other clonal eosinophilic disorders lacking this rearrangement could behave in a similar fashion through different pathogenic mechanisms.
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