Acute lymphocytic leukemia with eosinophilia: two case reports and a literature review.
ABSTRACT 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.
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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.04/2013; 2013:652745. DOI:10.1155/2013/652745
- Leukemia and Lymphoma 08/2007; 48(7):1417-9. DOI:10.1080/10428190701361836 · 2.61 Impact Factor
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ABSTRACT: This report describes the long-term (23 years) follow-up of a pediatric patient with acute lymphoblastic leukemia and eosinophilia who underwent multiple valve replacements. An 8-year-old boy with this complex disease was admitted in January 1984 and treated with 6-week course of vincristine, L-asparaginase, and prednisolone, which induced complete remission. He developed atrioventricular valvular insufficiency and infectious endocarditis at 13.5 and 17.3 years of ages, respectively, with progressive development of congestive heart failure. At 18.6 years of age, he underwent prosthetic valve replacement of both atrioventricular valves; the mitral valve was replaced with a mechanical prosthetic valve and tricuspid valve with a bioprosthetic valve. Histopathological examination of the ventricular endomyocardium showed extensive fibrous degeneration and persistent infiltration of eosinophils and lymphocytes. The right-side prosthesis was replaced twice, at 22.4 and 29 years of ages, due to degeneration of bioleaflets and thrombosis of the mechanical valve, respectively. Although he tolerated all surgical procedures, he developed liver cancer at 31 years of age and died. Autopsy could not be performed. The present study indicates that a subset of patients in complete remission of acute lymphoblastic leukemia and eosinophilia can show persistent myocardial eosinophilic infiltration and are at risk of late cardiac disease.The Keio Journal of Medicine 01/2010; 59(2):64-8. DOI:10.2302/kjm.59.64