Eosinophilia during fludarabine treatment of chronic lymphocytic leukemia

Abstract

Although eosinophilia has been reported as a side effect of purine analogues, there is no report on fludarabine-induced eosinophilia in chronic lymphocytic leukemia (CLL). During chemotherapy with fludarabine and cyclophosphamide, we observed two cases of significant eosinophilia. A 67-year-old patient with CLL developed bone marrow and peripheral blood eosinophilia up to 7.9x10(9)/l, the highest eosinophil count ever reported during treatment with a purine analogue. The eosinophilia persisted for 33 days. Another patient developed bone marrow eosinophilia without eosinophilia in the peripheral blood. These are the first documented cases of fludarabine-induced eosinophilia in CLL, and this side effect may conceivably be more common than previously recognized.

Abnormal eosinophil count at CLL diagnosis correlates with shorter treatment free survival

“…2 Achieving complete metabolic remission (CMR) on fluorodeoxyglucose positron emission tomography (FDG-PET) prior to autologous stem cell transplant (ASCT) is highly predictive for continuing progression-free survival (PFS). 3 Novel agents are incorporated into later salvage treatment. Brentuximab vedotin (Bv) achieved a 33% CR when used as monotherapy in children and young people.…”

“…Blood eosinophilia may be an early sign of a haematological malignancy 1,2 . Temporary eosinophilia occurs as an adverse event in chronic lymphocytic leukaemia (CLL) during fludarabine treatment, 3 whereas persistent eosinophilia in CLL with a TP53 mutation may be a prognostic factor for variant Richter transformation 4 . A dose‐dependent association between eosinophil counts and the risk of CLL has been reported 5 .…”

Systemic eosinophilia with skin and pulmonary infiltrates in a patient with chronic lymphocytic leukemia: A case report

“…Severe eosinophilia may be associated with hematological malignancies such as chronic myeloproliferative disorders and, usually with less pronounced eosinophilic counts, with CLL, HL, [1] and fludarabine treatment. [4] Clonal eosinophilia was unlikely considering negative tests for the FIP1L1-PDGFRalpha fusion gene and the JAK2 V617F mutation. Eosinophilic pneumonia after fludarabine treatment has been reported previously.…”

“…The differential diagnosis of eosinophilia is very wide, including infection, allergic diseases, myeloproliferative disorders, [1] lymphoid malignancies, [2,3] side effects of medical treatment of CLL with fludarabine, [4] and other causes. [5] We present and discuss the case of a patient who developed dramatic clinical features: rapid deterioration of performance status, high fever, extremely high eosinophilic counts in peripheral blood, as well as eosinophilic infiltrates in skin and lungs.…”

Solute Carrier Nucleoside Transporters in Hematopoiesis and Hematological Drug Toxicities: A Perspective

“…Numerous studies on chronic lympho-cytic leukemia have indicated that 10 to 25% of patients suffered from anemia [61][62][63], 4 to 42% from thrombocytopenia [93][94][95][96][97], and 10% from neutropenia, after administration of fludarabine at a dosage level of 25-30 mg/m 2 /day [93,129,130]. A few reports have revealed the development of eosinophilia in non-Hodgkin's lymphoma and chronic lymphocytic leukemia patients with a peak eosinophil count of 7.9 × 10 9 /L [140][141][142] (Table 2).…”