Acute Eosinophilic Leukemia in a Patient with Preexistent Myelodysplastic Syndrome

Abstract

A case of acute eosinophilic leukemia (EoL) that occurred in a patient with preexistent myelodysplastic syndrome is reported. The patient was initially diagnosed as having refractory anemia (RA) on the basis of pancytopenia with dysplasia and chromosomal abnormalities. Two years later, he was readmitted because of progression of pancytopenia, and bone marrow and peripheral blood showed immature dysplastic eosinophils. Clonal assay of peripheral blood mononuclear cells revealed autonomous growth of colony-forming unit eosinophils. Cytotoxic chemotherapy did not induce remission, and extensive myelofibrosis developed. Cytogenetic analysis in the RA state showed +1p^- and -7 whereas complicated abnormalities including +1p^-, 3q^- and 7p^- dominated in the EoL state.

Prevalence and clinical characteristics of myelodysplastic syndrome with bone marrow eosinophilia or basophilia

“…Monosomy 7 has been reported in cases of acute leukemia in association with more than 5% bone marrow eosinophils. 34,35 An increased basophil count was also observed in MDS patients with specific cytogenetic abnormalities, such as i(17q) and t(6;9)(q23;q34.3). 11,24-26 Four case reports have described MDS with prominent basophilia and complex karyotypes.…”

The eosinophilias, including the idiopathic hypereosinophilic syndrome

“…Monosomy 7 is a common finding in patients with MDS and has also been reported in patients with acute leukaemia in association with more than 5% bone marrow eosinophils (Vardiman et al , 1982; Kwong & Chan, 1994). These are possibly patients with AML developing on a background of MDS (Muraka et al , 1991) or with therapy‐related eosinophilic leukaemia (Imai et al , 1996; Muroi et al , 1996). Doorduijn et al (1996) described a patient with hypereosinophilia of unknown aetiology with normal cytogenetics for 24 years.…”

Refractory Anaemia with Hypereosinophilia and Clonal Abnormal Metaphases Detected only in the Neutrophilic Granulopoietic Series

“…in the FAB M4 subtype with eosinophilia [1,2], in acute myeloge nous leukaemia associated with t(8;21) [3], and in the socalled eosinophilic leukaemia, an entity doubted by some authors, while others have given strict criteria for its diag nosis [4]. A pre-existent myelodysplastic syndrome termi nating in an acute eosinophilic leukaemia has also been reported [5].…”