Abstract
Eosinophilia is rare in acute leukemia at presentation. Discrete reports and case studies in recent years have created significant interest in the field of “Acute leukemia with eosinophilia”. We herein present two cases of eosinophilia in association with acute lymphoblastic leukemia with brief review of literature in this field. First case is about 21-year-old female who presented with mediastinal mass along with leukocytosis and hypereosinophilia. On evaluation, she was found to have T cell acute lymphoblastic leukemia. After ruling out benign causes of eosinophilia, she was treated with modified BFM-90 protocol. Her eosinophilia resolved after 4 weeks of induction therapy. Second case is about 32-year-old male who was diagnosed as a case of mixed phenotype leukemia (B cell/myeloid type) along with severe eosinophilia. His hypereosinophilia finally resolved by week 16 of modified BFM-90 protocol. Diagnosing ALL is challenging when eosinophilia is the initial presentation. These two cases emphasize on the importance of considering ALL amongst one of the etiological causes of eosinophilia as delay in diagnosis endangers patient’s life at risk. Also eosinophilia per se is an independent poor risk factor, hence prompt diagnosis and early treatment is the key in all such cases.
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References
Spitzer G, Garson OM (1973) Lymphoblastic leukemia with marked eosinophilia: a report of two cases. Blood 42(3):377–841
Hogan TF, Koss W, Murgo AJ, Amato RS, Fontana JA, VanScoy FL (1987) Acute lymphoblastic leukemia with chromosomal 5;14 translocation and hypereosinophilia: case report and literature review. J Clin Oncol 5(3):382–390
Baumgarten E, Wegner RD, Fengler R, Ludwig WD, Schulte-Overberg U, Domeyer C et al (1989) Calla-positive acute leukaemia with t (5q;14q) translocation and hypereosinophilia–a unique entity. Acta Haematol 82(2):85–90
Fletcher S, Bain B (2007) Eosinophilic leukaemia. Br Med Bull 81–82:115–127
Ayhan AC, Timur C, Ayhan Y, Cakir B, Erguven M (2012) Does hypereosinophilic syndrome precede common B acute lymphoblastic leukaemia in childhood? A case report. Acta Haematol 127(2):90–92
Albano F, Anelli L, Zagaria A, Coccaro N, Tota G, Impera L et al (2014) Acute myeloid leukemia with t(16;16) (p13;q22) showing a new CBFB-MYH11 fusion transcript associated with an atypical leukemic blasts morphology. Hum Pathol 45(3):643–647
Sreedhara S, Grinfeld J, Bain BJ (2013) The peripheral blood features of acute myeloid leukemia with inv(16)(p13.1q22). Am J Hematol 88(11):975
Tan AM, Downie PJ, Ekert H (1987) Hypereosinophilia syndrome with pneumonia in acute lymphoblastic leukaemia. Aust Paediatr J 23(6):359–361
Tono-oka T, Sato Y, Matsumoto T, Ueno N, Ohkawa M, Shikano T et al (1984) Hypereosinophilic syndrome in acute lymphoblastic leukemia with a chromosome translocation [t(5q;14q)]. Med Pediatr Oncol 12(1):33–37
Amshalom A, Lev A, Trakhtenbrot L, Golan H, Weiss B, Amariglio N et al (2013) Severe eosinophilia in children: a diagnostic dilemma. J Pediatr Hematol Oncol 35(4):303–306
Rezamand A, Ghorashi Z, Ghorashi S, Nezami N (2013) Eosinophilic presentation of acute lymphoblastic leukemia. Am J Case Rep 14:143–146
Song G, Liu H, Sun F, Gu L, Wang S (2012) Acute lymphocytic leukemia with eosinophilia: a case report and review of the literature. Aging Clin Exp Res 24(5):555–558
Gharabaghi MA, Aghajanzadeh P, Zahedi G, Borji R, Derakhskan L, Sattarzadeh R, et al. (2012). Cardiac disease in a case of precursor B acute lymphoblastic leukaemia with eosinophilia(ALL/Eo). BMJ Case Rep 2012. doi:10.1136/bcr.04.2011.4128
Larsen MV, Karstoft K, Andersen MK (2011) Acute lymphatic leukaemia with eosinophilia in a younger man returning from a travel in the tropics–case report. Ugeskr Laeger 173(19):1363–1364
Bae SY, Yoon SY, Huh JH, Sung HJ, Choi IK (2007) Hypereosinophilia in biphenotypic (B-cell/T-cell) acute lymphoblastic leukemia. Leuk Lymphoma 48(7):1417–1419
Bhatti FA, Hussain I, Ali MZ (2009) Adult B lymphoblastic leukaemia/lymphoma with hypodiploidy (-9) and a novel chromosomal translocation t(7;12)(q22;p13) presenting with severe eosinophilia–case report and review of literature. J Hematol Oncol 2:26
Li F, Zhai YP (2013). 8p11 myeloproliferative syndrome. Zhongguo shi yan xue ye xue za zhi/Zhongguo bing li sheng li xue hui (J Exp Hematol/Chin Assoc Pathophysiol) 21(4):1073–7
Nunez CA, Zipf TF, Roberts WM, Medeiros LJ, Hayes K, Bueso-Ramos CE (2003) Molecular monitoring of cerebrospinal fluid can predict clinical relapse in acute lymphoblastic leukemia with eosinophilia. Arch Pathol Lab Med 127(5):601–605
Trimaldi J, Carballido EM, Bowers JW, Anguiano AL, Zhang ZJ, Shah BD et al (2013) B-lymphoblastic leukemia/lymphoma associated with t(8;13)(p11;q12)/ZMYM2 (ZNF198)-FGFR1: rare case and review of the literature. Acta Haematol 130(3):127–134
Harisi M, Douna V, Baka M, Servitzoglou M, Kosmidi H, Anastasiou T (2010) Severe Eosinophilia in an infant with congenital acute myeloid leukemia with t(3;4;6)(q26;q25;q21): a case report. J Pediatr Hematol Oncol 32(6):497–500
Park IJ, Park JE, Kim HJ, Jung HJ, Lee WG, Cho SR (2010) Acute myeloid leukemia with t(16;21)(q24;q22) and eosinophilia: case report and review of the literature. Cancer Genet Cytogenet 196(1):105–108
Walz C, Erben P, Ritter M, Bloor A, Metzgeroth G, Telford N et al (2011) Response of ETV6-FLT3-positive myeloid/lymphoid neoplasm with eosinophilia to inhibitors of FMS-like tyrosine kinase 3. Blood 118(8):2239–2242
Fishel RS, Farnen JP, Hanson CA, Silver SM, Emerson SG (1990) Acute lymphoblastic leukemia with eosinophilia. Medicine 69(4):232–243
Wynn TT, Heerema NA, Hammond S, Ranalli M, Kahwash SB (2003) Acute lymphoblastic leukemia with hypereosinophilia: report of a case with 5q deletion and review of the literature. Pediatr Dev Pathol 6(6):558–563
Al-Riyami AZ, Hudoba M, Young S, Forrest D (2013) Sorafenib is effective for imatinib-resistant FIP1L1/PDGFRA T674I mutation-positive acute myeloid leukemia with eosinophilia. Leuk Lymphoma 54(8):1788–1790
Vijay S, Sarojam S, Raveendran S, Syamala V, Leelakumari S, Narayanan G et al (2012) Recurrent isochromosome 21 and multiple abnormalities in a patient suspected of having acute myeloid leukemia with eosinophilic differentiation—a rare case from South India. Chin J Cancer 31(1):45–50
Rahman K, George S, Sardana M, Mehta A (2013) Microfilariae with acute myeloid leukemia: a common parasite with uncommon association. Indian J Hematol Blood Transfus 29(2):113–115
Nesheli HM, Moghaddam TG, Zahedpasha Y, Norouzi AR (2011) Acute lymphoblastic leukemia with eosinophilia and Strongyloides stercoralis hyperinfection. Iran J Pediatr 21(4):549–552
George S, Kumar P, Quarta G, Shankar A, Hough R, Samarasinghe S (2012) Loeffler myocarditis in pre-B acute lymphoblastic leukaemia with t(5;14)(q31;q32). Br J Haematol 157(5):517
Tsuji A, Sasaki M, Ishii T, Sato S, Kanki H, Suzuki S et al (2010) Persistent eosinophilic infiltration of the myocardium in a child in complete remission of acute lymphoblastic leukemia and eosinophilia. Potential role in late cardiac disease. Keio J Med 59(2):64–68
Nie YL, Jan SL, Fu LS, Chang TK, Wang JD (2010) Congestive heart failure as presentation of acute lymphoblastic leukaemia with eosinophilia. Br J Haematol 149(5):633
Schiff DE, Ortega JA (1992) Chorea, eosinophilia, and lupus anticoagulant associated with acute lymphoblastic leukemia. Pediatr Neurol 8(6):466–468
Youinou P, Andrieu JM, Casassus P (1979) Acute lymphoblastic leukemia associated with blood and cerebrospinal fluid eosinophilia. La Nouvelle Presse Med 8(7):527
Law KL, Nang K, Lin HY, Chi CS (1989). [Cerebrospinal fluid eosinophilia preceding central nervous system leukemia]. Zhonghua yi xue za zhi = Chin Med J; Free China ed 43(4): 273–6
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Sahu, K.K., Malhotra, P., Khadwal, A. et al. Hypereosinophilia in Acute Lymphoblastic Leukemia: Two Cases with Review of Literature. Indian J Hematol Blood Transfus 31, 460–465 (2015). https://doi.org/10.1007/s12288-014-0436-7
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DOI: https://doi.org/10.1007/s12288-014-0436-7