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.
Highlights
Hypereosinophilia (HE) can be associated with a wide range of both reactive and malignant disorders
The association between acute lymphoblastic leukemia (ALL) and eosinophilia was first described by Spitzer and Garson in 1973 [2]
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 [1]
Summary
Hypereosinophilia (HE) can be associated with a wide range of both reactive and malignant disorders. HE may appear in disorders where the eosinophils are a part of the malignant clone, such as the myeloproliferative neoplasms, or result from stimulation by growth factors or cytokines produced by the malignant clone. These include lymphoproliferative neoplasms, T-cell non-Hodgkin lymphoma, and Hodgkin lymphoma. Its appearance sometimes precedes the diagnosis of malignancy by several years [3], and after the exclusion of reactive causes, the presence of eosinophilia should lead to the investigation of an underlying clonal disease
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