Hypereosinophilia in Acute Lymphoblastic Leukemia: Two Cases with Review of Literature

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-yearold 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.

Acute Lymphoblastic Leukemia with Hypereosinophilia in a Child: Case Report and Literature Review

“…Cases of HE secondary to ALL are very rare. In addition to this child, only 61 patients <25 years (mean age 11 years) with HE and ALL have been described since 1973 to December 2017 ( Table 1 ) [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ].…”

Eosinophils from Physiology to Disease: A Comprehensive Review

“…Only rarely HE criteria are also met [ 178 , 179 ]. Furthermore, eosinophilia can be a feature of other chronic lymphoid diseases as well as of acute lymphoblastic leukaemia [ 180 – 183 ], where it can associate with organ damage and affect prognosis. An overall treatment response usually correlates with remission of eosinophilia.…”

Hypereosinophilia in a Young Patient: Occam’s Razor or Hickam’s Dictum?

“…Reactive eosinophilia can also occur with asthma but eosinophilia with asthma should prompt consideration of allergic bronchopulmonary aspergillosis and eosinophilic granulomatosis with polyangitis (Churg-Strauss syndrome). Sinister causes include adenocarcinomas, Hodgkin disease, some T cell lymphomas and acute myeloid and lymphoblastic leukemias [1]. When reactive causes are not found patient is thought to have hypereosinophilic syndrome (HES).…”