The role of eosinophil morphology in distinguishing between reactive eosinophilia and eosinophilia as a feature of a myeloid neoplasm

Goasguen, J; Bennett, John M.; Bain, Barbara J.; Brunning, Richard D.; Zini, Gina; Vallespi, Maria-Teresa; Tomonaga, Masao; Locher, Clara

doi:10.1111/bjh.17026

Cited by 21 publications

(17 citation statements)

References 2 publications

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“…A systematic study comparing reactive and neoplastic cases reported that, although there was a tendency to more marked morphological abnormalities in those with clonal neoplastic eosinophils, there was considerable overlap. 1 The feature most strongly associated with neoplasia, particularly because of its association with inv( 16), was the presence of immature basophilic granules but as demonstrated in this patient, even this is not specific for neoplasia.…”

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confidence: 53%

Eosinophil morphology in the reactive eosinophilia of Hodgkin lymphoma

2021

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A 35-year-old woman with stage IVB refractory Hodgkin lymphoma, mixed cell type, who had initially presented 18 months earlier, developed marked leukocytosis with striking eosinophilia with disease progression.The eosinophils showed notable morphological abnormalities (all images, Â100 objective) including degranulation, vacuolation, granules that were smaller than normal and granules in mature eosinophils that had basophilic staining characteristics. There were some hyperlobated nuclei, some non-segmented nuclei (top right) and some ring nuclei (bottom right).

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confidence: 53%

Eosinophil morphology in the reactive eosinophilia of Hodgkin lymphoma

2021

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“…68 In contrast, eosinophil morphology in isolation has poor specificity for a myeloid neoplasm. 69,70 Lymphocyte-variant HE is a more obscure diagnostic entity characterized by an abnormal T-cell population demonstrated by flow immunophenotyping, which may be associated with excessive eosinophilopoietic cytokine production in vitro (eg, serum IL-5). 21,71,72 If none of the aforementioned conditions is identified, a diagnosis of idiopathic HES is made if organ damage is present, and a diagnosis of idiopathic HE is rendered if organ compromise is not found.…”

Section: Clinical Presentationmentioning

confidence: 99%

World Health Organization‐defined eosinophilic disorders: 2022 update on diagnosis, risk stratification, and management

2021

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Disease Overview: The eosinophilias encompass a broad range of nonhematologic (secondary or reactive) and hematologic (primary or clonal) disorders with potential for end-organ damage.Diagnosis: Hypereosinophilia (HE) has generally been defined as a peripheral blood eosinophil count greater than 1.5 Â 10 9 /L. After exclusion of secondary causes of eosinophilia, diagnostic evaluation of primary eosinophilias relies on morphologic review of the blood and marrow, standard cytogenetics, fluorescence in situ hybridization, next generation sequencing gene assays, and flow immunophenotyping to detect histopathologic or clonal evidence for an acute or chronic hematolymphoid neoplasm.Risk Stratification: Disease prognosis relies on identifying the subtype of eosinophilia. After evaluation of secondary causes of eosinophilia, the 2016 World Health Organization endorses a semi-molecular classification scheme of disease subtypes. This includes the major category "myeloid/lymphoid neoplasms with eosinophilia and rearrangement of PDGFRA, PDGFRB, or FGFR1 or with PCM1-JAK2", and the myeloproliferative neoplasm subtype, "chronic eosinophilic leukemia, not otherwise specified" (CEL, NOS). Lymphocyte-variant HE is an aberrant T-cell clone-driven reactive eosinophila, and idiopathic hypereosinophilic syndrome (HES) is a diagnosis of exclusion. Risk-adapted Therapy:The goal of therapy is to mitigate eosinophil-mediated organ damage. For patients with milder forms of eosinophilia (eg, < 1.5 Â 10 9 /L) without symptoms or signs of organ involvement, a watch and wait approach with close follow-up may be undertaken. Identification of rearranged PDGFRA or PDGFRB is critical because of the exquisite responsiveness of these diseases to imatinib. Corticosteroids are first-line therapy for patients with lymphocyte-variant HE and HES.Hydroxyurea and interferon-α have demonstrated efficacy as initial treatment and in steroid-refractory cases of HES. Mepolizumab, an interleukin-5 (IL-5) antagonist monoclonal antibody, was recently approved by the US Food and Drug Administration for patients with idiopathic HES. The use of the IL-5 receptor antibody benralizumab, as well as other targeted therapies such as JAK2 and FGFR1 inhibitors, is under active investigation.

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“…Previous reports have been called either acute eosinophilic leukemia (AEL) or acute myeloid leukemia with eosinophilia [ 10 , 11 ]. Eosinophil dysplasia has been noted in both benign and neoplastic disorders but may be helpful in the differential diagnosis of potential myeloid neoplasms [ 12 ]. We prefer the term AEL as being consistent with other AML subtypes.…”

Section: Discussionmentioning

confidence: 99%

A Case of Acute Eosinophilic Leukemia with a Novel PHF6 Mutation

Lipof

Huselton

Zent

et al. 2021

Case Reports in Hematology

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Acute eosinophilic leukemia (AEL) is a rare form of acute myeloid leukemia (AML) that requires prompt exclusion of reactive etiologies of eosinophilia and identification of an underlying acute myeloid neoplasm. Myeloid neoplasms with prominent eosinophilia often have rearrangements in the platelet-derived growth factor receptor α (PDGFRA) or β (PDGFRB) or are associated with core-binding factor AML. In this report, we describe a 35-year-old male presenting with chest discomfort and altered mental status, found to have marked leukocytosis with eosinophilic predominance and an elevated blast count. Bone marrow aspirate and biopsy findings were morphologically consistent with AEL. Fluorescence in situ hybridization (FISH) and standard karyotype analysis did not reveal any abnormalities, and mutation analysis using next generation sequencing (NGS) revealed a pathogenic mutation in PHF6. Cardiac work-up revealed findings suggestive of eosinophilic myocarditis. High-dose glucocorticoid therapy was initiated followed by standard intensive induction chemotherapy with cytarabine and idarubicin. He experienced a rapid reduction in peripheral blood eosinophil and blast count and was found to be in a complete remission at the time of his postinduction bone marrow examination. He underwent allogeneic stem cell transplantation with a matched sibling donor after consolidative high-dose cytarabine and remains in remission at the time of this report, 6 months following his initial diagnosis. The rarity of this condition has resulted in a paucity of data to guide management. Additional studies are needed to better characterize this entity and inform optimal management strategies to attain a long-term sustained remission in these patients.

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The role of eosinophil morphology in distinguishing between reactive eosinophilia and eosinophilia as a feature of a myeloid neoplasm

Cited by 21 publications

References 2 publications

Eosinophil morphology in the reactive eosinophilia of Hodgkin lymphoma

Eosinophil morphology in the reactive eosinophilia of Hodgkin lymphoma

World Health Organization‐defined eosinophilic disorders: 2022 update on diagnosis, risk stratification, and management

A Case of Acute Eosinophilic Leukemia with a Novel PHF6 Mutation

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