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Chapter 13 - Myeloid and Lymphoid Neoplasms Associated with Eosinophilia

Published online by Cambridge University Press:  12 November 2020

Jon van der Walt
Affiliation:
St Thomas’ Hospital, London
Attilio Orazi
Affiliation:
Texas Tech University
Daniel A. Arber
Affiliation:
University of Chicago
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Summary

Myeloid and lymphoid neoplasms with eosinophilia (MLNE) and rearrangements of PDGFRA, PDGFRB and FGFR1 were recognized as a standalone category in the 2008 WHO classification. PCM1-JAK2 was added to this family as a new provisional entity in the 2016 WHO classification [1, 2]. The features shared by neoplasms in this category include a common presentation with eosinophilia or hypereosinophilia in peripheral blood and an increased number of eosinophilic forms in bone marrow (BM). Some cases present as acute leukaemia. Some cases may lack hypereosinophilia. The underlying mechanism is the overexpression of an aberrant tyrosine kinase as a result of a fusion gene, or rarely of a mutation, and a diagnosis and classification requires the demonstration of the specific gene fusions. The cell of origin is a mutated pluripotent stem cell that has the potential to involve myeloid, lymphoid or both lineages, concomitantly or sequentially, leading to clinically complex and heterogeneous manifestations. A common scenario is the presentation as a chronic myeloproliferative neoplasm (MPN), usually with eosinophilia followed within a variable time period and depending on the gene fusion involved, by a progression to acute myeloid leukaemia (AML) or mixed phenotype acute leukaemia (usually in the BM), and B- or T-lymphoblastic leukaemia/lymphoma (B-/T-ALL) in BM or in an extramedullary site. Thus it is critical to recognize the clinicopathologic features of these neoplasms, identify the molecular genetic lesions and classify them accordingly. An accurate diagnosis and classification have important therapeutic and prognostic implications.

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Publisher: Cambridge University Press
Print publication year: 2021

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References

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Weide, R, Rieder, H, Mehraein, Y, et al. Chronic eosinophilic leukaemia (CEL): a distinct myeloproliferative disease. Br J Haematol. 1997;96:117–23.Google Scholar
Ogbogu, PU, Bochner, BS, Butterfield, JH, et al. Hypereosinophilic syndrome: a multicenter, retrospective analysis of clinical characteristics and response to therapy. J Allergy Clin Immunol. 2009;124:1319–25 e3.Google Scholar
Lefebvre, C, Bletry, O, Degoulet, P, et al. [Prognostic factors of hypereosinophilic syndrome. Study of 40 cases]. Ann Med Interne (Paris). 1989;140:253–7.Google Scholar
Khoury, P, Makiya, M, Klion, AD. Clinical and biological markers in hypereosinophilic syndromes. Front Med (Lausanne). 2017;4:240.Google Scholar
Simon, HU, Plotz, SG, Dummer, R, Blaser, K. Abnormal clones of T cells producing interleukin-5 in idiopathic eosinophilia. N Engl J Med. 1999;341:1112–20.Google Scholar
Bain, BJ, Gilliland, DG, Vardiman, JW, Horny, H-P. Chronic eosinophilic leukemia, not otherwise specified. In Swerdlow, SH, Campo, E, Lee Harris, N, et al. (eds) WHO Classification of Tumors of Haematopoietic and Lymphoid Tissues: Lyon: IARC Press; 2008:51–3.Google Scholar
Bain, BJ, Horny, HP, Hasserjian, RP, Orazi, A. Chronic Eosinophilic Leukaemia, NOS. Lyons: IARC Press; 2017.Google Scholar
Schwaab, J, Umbach, R, Metzgeroth, G, et al. KIT D816V and JAK2 V617F mutations are seen recurrently in hypereosinophilia of unknown significance. Am J Hematol. 2015;90:774–7.Google Scholar
Bacher, U, Reiter, A, Haferlach, T, et al. A combination of cytomorphology, cytogenetic analysis, fluorescence in situ hybridization and reverse transcriptase polymerase chain reaction for establishing clonality in cases of persisting hypereosinophilia. Haematologica. 2006;91:817–20.Google Scholar
Lee, JS, Seo, H, Im, K, et al. Idiopathic hypereosinophilia is clonal disorder? Clonality identified by targeted sequencing. PLoS One. 2017;12:e0185602.Google Scholar
Cross, NCP, Hoade, Y, Tapper, WJ, et al. Recurrent activating STAT5B N642H mutation in myeloid neoplasms with eosinophilia. Leukemia. 2018.Google Scholar
Cargo, CA, Rowbotham, N, Evans, PA, et al. Targeted sequencing identifies patients with preclinical MDS at high risk of disease progression. Blood. 2015;126:2362–5.Google Scholar
Steensma, DP, Bejar, R, Jaiswal, S, et al. Clonal hematopoiesis of indeterminate potential and its distinction from myelodysplastic syndromes. Blood. 2015;126:916.Google Scholar
Carruthers, MN, Park, S, Slack, GW, et al. IgG4-related disease and lymphocyte-variant hypereosinophilic syndrome: a comparative case series. Eur J Haematol. 2017;98:378–87.Google Scholar
Bain, BJ, Gilliland, DG, Horny, H-P, Vardiman, JW. Myeloid and lymphoid neoplasms with eosinophilia and abnormalities of PDGFRA, PDGFRB or FGFR1. In Swerdlow, SH, Campo, E, Harris, NL, et al. (eds) WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Lyon: International Agency for Research on Cancer (IARC); 2008:6873.Google Scholar
Crane, MM, Chang, CM, Kobayashi, MG, Weller, PF. Incidence of myeloproliferative hypereosinophilic syndrome in the United States and an estimate of all hypereosinophilic syndrome incidence. J Allergy Clin Immunol. 2010;126:179–81.Google Scholar
Helbig, G, Soja, A, Bartkowska-Chrobok, A, Kyrcz-Krzemien, S. Chronic eosinophilic leukemia-not otherwise specified has a poor prognosis with unresponsiveness to conventional treatment and high risk of acute transformation. Am J Hematol. 2012;87:643–5.Google Scholar
Weide, R, Rieder, H, Mehraein, Y, et al. Chronic eosinophilic leukaemia (CEL): a distinct myeloproliferative disease. Br J Haematol. 1997;96:117–23.Google Scholar
Ogbogu, PU, Bochner, BS, Butterfield, JH, et al. Hypereosinophilic syndrome: a multicenter, retrospective analysis of clinical characteristics and response to therapy. J Allergy Clin Immunol. 2009;124:1319–25 e3.Google Scholar
Lefebvre, C, Bletry, O, Degoulet, P, et al. [Prognostic factors of hypereosinophilic syndrome. Study of 40 cases]. Ann Med Interne (Paris). 1989;140:253–7.Google Scholar
Khoury, P, Makiya, M, Klion, AD. Clinical and biological markers in hypereosinophilic syndromes. Front Med (Lausanne). 2017;4:240.Google Scholar
Simon, HU, Plotz, SG, Dummer, R, Blaser, K. Abnormal clones of T cells producing interleukin-5 in idiopathic eosinophilia. N Engl J Med. 1999;341:1112–20.Google Scholar
Bain, BJ, Gilliland, DG, Vardiman, JW, Horny, H-P. Chronic eosinophilic leukemia, not otherwise specified. In Swerdlow, SH, Campo, E, Lee Harris, N, et al. (eds) WHO Classification of Tumors of Haematopoietic and Lymphoid Tissues: Lyon: IARC Press; 2008:51–3.Google Scholar
Bain, BJ, Horny, HP, Hasserjian, RP, Orazi, A. Chronic Eosinophilic Leukaemia, NOS. Lyons: IARC Press; 2017.Google Scholar
Schwaab, J, Umbach, R, Metzgeroth, G, et al. KIT D816V and JAK2 V617F mutations are seen recurrently in hypereosinophilia of unknown significance. Am J Hematol. 2015;90:774–7.Google Scholar
Bacher, U, Reiter, A, Haferlach, T, et al. A combination of cytomorphology, cytogenetic analysis, fluorescence in situ hybridization and reverse transcriptase polymerase chain reaction for establishing clonality in cases of persisting hypereosinophilia. Haematologica. 2006;91:817–20.Google Scholar
Lee, JS, Seo, H, Im, K, et al. Idiopathic hypereosinophilia is clonal disorder? Clonality identified by targeted sequencing. PLoS One. 2017;12:e0185602.Google Scholar
Cross, NCP, Hoade, Y, Tapper, WJ, et al. Recurrent activating STAT5B N642H mutation in myeloid neoplasms with eosinophilia. Leukemia. 2018.Google Scholar
Cargo, CA, Rowbotham, N, Evans, PA, et al. Targeted sequencing identifies patients with preclinical MDS at high risk of disease progression. Blood. 2015;126:2362–5.Google Scholar
Steensma, DP, Bejar, R, Jaiswal, S, et al. Clonal hematopoiesis of indeterminate potential and its distinction from myelodysplastic syndromes. Blood. 2015;126:916.Google Scholar
Carruthers, MN, Park, S, Slack, GW, et al. IgG4-related disease and lymphocyte-variant hypereosinophilic syndrome: a comparative case series. Eur J Haematol. 2017;98:378–87.Google Scholar

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