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Lübke J, Metzgeroth G, Reiter A, Schwaab J. Approach to the patient with eosinophilia in the era of tyrosine kinase inhibitors and biologicals. Curr Hematol Malig Rep 2024; 19:208-222. [PMID: 39037514 PMCID: PMC11416429 DOI: 10.1007/s11899-024-00738-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE OF REVIEW In this review, we aim to explore the optimal approach to patients presenting with eosinophilia, considering recent advances in diagnostic and therapeutic strategies. Specifically, we focus on the integration of novel therapies into clinical practice to improve patient outcomes. RECENT FINDINGS Advanced insights into the clinical and genetic features of eosinophilic disorders have prompted revisions in diagnostic criteria by the World Health Organization classification (WHO-HAEM5) and the International Consensus Classification (ICC). These changes reflect a growing understanding of disease pathogenesis and the development of targeted treatment options. The therapeutic landscape now encompasses a range of established and novel therapies. For reactive conditions, drugs targeting the eosinophilopoiesis, such as those aimed at interleukin-5 or its receptor, have demonstrated significant potential in decreasing blood eosinophil levels and minimizing disease flare-ups and relapse. These therapies have the potential to mitigate the side effects commonly associated with prolonged use of oral corticosteroids or immunosuppressants. Myeloid and lymphoid neoplasms with eosinophilia and tyrosine kinase (TK) gene fusions are managed by various TK inhibitors with variable efficacy. Diagnosis and treatment rely on a multidisciplinary approach. By incorporating novel treatment options into clinical practice, physicians across different disciplines involved in the management of eosinophilic disorders can offer more personalized and effective care to patients. However, challenges remain in accurately diagnosing and risk-stratifying patients, as well as in navigating the complexities of treatment selection.
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Affiliation(s)
- Johannes Lübke
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Georgia Metzgeroth
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Andreas Reiter
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Juliana Schwaab
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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2
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Yilmaz D, Sahin E. All-cause mortality and related factors in patients with varying degrees of peripheral blood eosinophilia. Medicine (Baltimore) 2024; 103:e38359. [PMID: 39259127 PMCID: PMC11142823 DOI: 10.1097/md.0000000000038359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 04/26/2024] [Accepted: 05/03/2024] [Indexed: 09/12/2024] Open
Abstract
The aim of this study was to investigate all-cause mortality rates and related factors in patients with different levels of eosinophilia. This retrospective cohort study was conducted between January 2020 and December 2022 in the Internal Medicine Department of Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkiye. A total of 161 patients with eosinophilia (at least 3 times) were included and divided into groups with absolute eosinophil counts of 500-999/µL (mild), 1000-1500/µL (moderate), and >1500/µL (severe). The mean age of patients was 65.67 ± 16.64 years at the time of admission, and 45 patients (57.8%) were male. The rates of mortality, oncological disease, and organ involvement were significantly higher in the severe group (P < .05). Increased serum total immunoglobulin E and vitamin B12, hematocrit value, eosinophil-to-lymphocyte ratio, and leukocyte were observed in eosinophilic patients. Decreased lymphocyte count, hemoglobin and hematocrit values were higher in deceased patients than in survivors (P < .05). Increased eosinophil-to-lymphocyte ratio, C-reactive protein, vitamin B12, and lactate dehydrogenase (LDH) activity were observed in participants who died compared to those who survived (P < .05). Multivariable logistic regression revealed that advanced age and higher LDH activity were independently associated with greater mortality risk while receiving non-steroid anti-inflammatory drugs or proton-pump inhibitors were associated with reduced mortality risk (P < .05). Advanced age and increased LDH activity were independently associated with greater risk for mortality, whereas absolute eosinophil counts was not. Considering the literature on this topic, our results show the need for further clinical and fundamental research to understand the role of eosinophils in human disease.
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Affiliation(s)
- Deniz Yilmaz
- Department of Internal Diseases, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ezgi Sahin
- Department of Rheumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
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3
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Laudien M. [Eosinophils in otorhinolaryngology: friend or foe?]. HNO 2024; 72:242-249. [PMID: 38436705 DOI: 10.1007/s00106-024-01442-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/05/2024]
Abstract
This article summarizes the essential aspects of current knowledge about eosinophils, classifies eosinophilia in terms of the dimensions healthy or harmful reaction, takes a specific look at eosinophils in the field of otorhinolaryngology, and gives recommendations for diagnostic workup and therapeutic intervention in case of proven eosinophilia, particularly as an adverse drug reaction. The thoughts are inspired by communications at the 29th Congress of the European Rhinologic Society in Sofia, Bulgaria, 2023.
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Affiliation(s)
- Martin Laudien
- Klinik für HNO-Heilkunde, Kopf- und Halschirurgie, UKSH, Campus Kiel, Christian-Albrechts-Universität zu Kiel, Arnold-Heller-Str. 3, Haus B1, 24105, Kiel, Deutschland.
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D’Aiuto V, Mormile I, Granata F, Romano A, Della Casa F, D’Onofrio C, Marzio V, Mignogna G, Califano L, de Paulis A, Rossi FW. Eosinophilic Patterns in Patients with Seasonal Allergy Affected by Bronchial Asthma and Rhinitis/Rhinosinusitis: Efficacy of Benralizumab in Patients with the Persistent Pattern. J Clin Med 2024; 13:754. [PMID: 38337448 PMCID: PMC10856349 DOI: 10.3390/jcm13030754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/19/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Eosinophilia can be influenced by multiple factors. This study aims to set a protocol for monitoring blood absolute eosinophil count (AEC) in patients with seasonal allergy affected by bronchial asthma (BA), allergic rhinitis (AR), or chronic rhinosinusitis with or without nasal polyposis (CRSw/sNP). METHODS We planned a total of four annual blood samples to measure AEC in- and out-seasonal pollen exposure (i.e., one measurement every three months for one year). RESULTS We identified two distinct groups of patients (non-eosinophilic and eosinophilic). Patients in the eosinophilic group presented with four different patterns (episodic, transient, floating, and persistent). Most patients with episodic, transient, and floating patterns were affected by mild allergy and the increase in eosinophils was related to allergen exposure. In contrast, patients with the persistent pattern mostly presented with more severe allergy (i.e., severe BA and relapsing CRSwNP) and the eosinophilia was unrelated to allergen exposure. The subgroup of patients with severe BA, relapsing CRSwNP, and persistent eosinophilc pattern were treated with benralizumab, which induced a noteworthy improvement in both severe BA and CRSwNP. CONCLUSIONS Multiple AEC measurements in patients with seasonal allergy can better reflect patient's eosinophilic status and help define the relationship of AEC enhancement with allergen exposure.
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Affiliation(s)
- Valentina D’Aiuto
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (V.D.); (F.G.); (F.D.C.); (A.d.P.); (F.W.R.)
| | - Ilaria Mormile
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (V.D.); (F.G.); (F.D.C.); (A.d.P.); (F.W.R.)
| | - Francescopaolo Granata
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (V.D.); (F.G.); (F.D.C.); (A.d.P.); (F.W.R.)
| | - Antonio Romano
- Head and Neck Section, Department of Neurosciences, Reproductive and Odontostomatological Science, University of Naples Federico II, 80131 Naples, Italy; (A.R.); (L.C.)
| | - Francesca Della Casa
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (V.D.); (F.G.); (F.D.C.); (A.d.P.); (F.W.R.)
| | - Caterina D’Onofrio
- Post-Graduate Program in Clinical Immunology and Allergy, University of Naples Federico II, 80131 Naples, Italy; (C.D.); (V.M.); (G.M.)
| | - Valentina Marzio
- Post-Graduate Program in Clinical Immunology and Allergy, University of Naples Federico II, 80131 Naples, Italy; (C.D.); (V.M.); (G.M.)
| | - Gabriele Mignogna
- Post-Graduate Program in Clinical Immunology and Allergy, University of Naples Federico II, 80131 Naples, Italy; (C.D.); (V.M.); (G.M.)
| | - Luigi Califano
- Head and Neck Section, Department of Neurosciences, Reproductive and Odontostomatological Science, University of Naples Federico II, 80131 Naples, Italy; (A.R.); (L.C.)
| | - Amato de Paulis
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (V.D.); (F.G.); (F.D.C.); (A.d.P.); (F.W.R.)
- Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, 80131 Naples, Italy
| | - Francesca Wanda Rossi
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (V.D.); (F.G.); (F.D.C.); (A.d.P.); (F.W.R.)
- Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, 80131 Naples, Italy
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Taniguchi H, Kaneko M, Kiriu N, Kiyozumi T. Cardiac tamponade due to eosinophilia treated with intravenous corticosteroid: A case report. Medicine (Baltimore) 2023; 102:e34410. [PMID: 37543825 PMCID: PMC10402997 DOI: 10.1097/md.0000000000034410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2023] Open
Abstract
RATIONALE Cardiac tamponade, a condition in which the heart is compressed by pericardial fluid retention, is easy to diagnose; however, identifying the cause may be challenging since it can be caused by a variety of conditions, including trauma and pericardial disease. PATIENT CONCERNS A 22-year-old man was admitted to the intensive care unit with respiratory failure. He had previously received allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia and developed chronic graft-versus-host disease (cGvHD) that was treated with a corticosteroid. At this time, he developed bilateral femur head necrosis and underwent surgery after discontinuation of the corticosteroid but developed respiratory failure postoperatively. The initial diagnosis was cardiac failure, which temporarily improved with treatment; however, eosinophilia and pericardial effusions became prominent. DIAGNOSES Pericardial effusion gradually progressed, resulting in cardiac tamponade. INTERVENTIONS Pericardiocentesis was performed. Eosinophilia could be the cause of cardiac tamponade; thus, corticosteroid was administered. OUTCOMES Pericardial effusion improved remarkably after corticosteroid administration. The corticosteroid dose was gradually tapered, and the patient was discharged. LESSONS This case presented with cardiac tamponade associated with eosinophilia, probably owing to graft-versus-host disease. This is an unusual condition associated with a history of hematologic neoplasms; although evaluation is challenging, appropriate assessment could help save the patient's life.
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Affiliation(s)
- Hiroaki Taniguchi
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan
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Khoury P, Akuthota P, Kwon N, Steinfeld J, Roufosse F. HES and EGPA: Two Sides of the Same Coin. Mayo Clin Proc 2023; 98:1054-1070. [PMID: 37419574 PMCID: PMC10348452 DOI: 10.1016/j.mayocp.2023.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/03/2023] [Accepted: 02/15/2023] [Indexed: 07/09/2023]
Abstract
Elevated eosinophil counts are implicated in multiple diseases, from relatively prevalent organ-specific disorders such as severe eosinophilic asthma, to rare multisystem disorders such as hypereosinophilic syndrome (HES) and eosinophilic granulomatosis with polyangiitis (EGPA). Patients with these multisystem diseases, often associated with markedly elevated eosinophil counts, have a substantial risk of morbidity and mortality due to delayed diagnosis or inadequate treatment. A thorough workup of symptomatic patients presenting with elevated eosinophil counts is essential, although in some cases the differential diagnosis may remain difficult because of overlapping presentations between HES and EGPA. Notably, first- and second-line treatment options and response to therapy may differ for specific HES and EGPA variants. Oral corticosteroids are the first line of treatment for HES and EGPA, except when HES is the result of specific mutations driving clonal eosinophilia that are amenable to targeted treatment with a kinase inhibitor. Cytotoxic or immunomodulatory agents may be required for those with severe disease. Novel eosinophil-depleting therapies, such as those targeting interleukin 5 or its receptor, have shown great promise in reducing blood eosinophil counts, and reducing disease flares and relapses in patients with HES and EGPA. Such therapies could reduce the side effects associated with long-term oral corticosteroids or immunosuppressant use. This review provides a pragmatic guide to approaching the diagnosis and clinical management of patients with systemic hypereosinophilic disorders. We highlight practical considerations for clinicians and present cases from real-world clinical practice to show the complexity and challenges associated with diagnosing and treating patients with HES and EGPA.
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Affiliation(s)
- Paneez Khoury
- Eosinophil Clinical Research Unit, LPD, National Institute of Health, Bethesda, MD, USA
| | | | - Namhee Kwon
- Respiratory Research & Development, GSK, GSK House, Brentford, Middlesex, UK
| | | | - Florence Roufosse
- Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
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Laguna J, Rodríguez-García M, Molina A, Merino A. Kimura disease as an uncommon cause of persistent hypereosinophilia: a diagnostic challenge. Biochem Med (Zagreb) 2023; 33:020801. [PMID: 37143713 PMCID: PMC10152615 DOI: 10.11613/bm.2023.020801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/26/2023] [Indexed: 05/06/2023] Open
Abstract
Kimura disease (KD) is an unusual inflammatory disease of unknown etiology. Despite being described many years ago, KD might cause diagnostic difficulty or be confused with other conditions. Here, we present a 33-year-old Filipino woman who was referred to our hospital for evaluation of persistent eosinophilia and intense pruritus. Blood analysis and peripheral blood smear review showed high eosinophil counts (3.8 x109/L, 40%) that did not show morphological abnormalities. Besides, high serum IgE concentration was detected (33,528 kU/L). Serological tests were positive for Toxocara canis and treatment with albendazol was initiated. Nevertheless, increased eosinophil counts were still present after several months, alongside with high serum IgE concentrations and intense pruritus. During her follow-up, an inguinal adenopathy was detected. The biopsy revealed lymphoid hyperplasia with reactive germinal centers and massive eosinophil infiltration. Proteinaceous deposits of eosinophilic material were also observed. All these findings, together with peripheral blood eosinophilia and high IgE concentrations, confirmed the diagnosis of KD. The diagnosis of KD should be considered in the differential diagnosis of long-standing unexplained eosinophilia in association with high IgE concentrations, pruritus and lymphadenopathies.
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8
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Chen B, Rong Q, Fu Y, Liang H, Kong X, Zhang Q, Jiang M, Wang Z, Xie J. Characteristics of patients with incidental eosinophilia admitted to a tertiary hospital in southern China. Heliyon 2023; 9:e15569. [PMID: 37144198 PMCID: PMC10151328 DOI: 10.1016/j.heliyon.2023.e15569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 03/12/2023] [Accepted: 04/13/2023] [Indexed: 05/06/2023] Open
Abstract
Background The characteristics of patients with eosinophilia are heterogeneous and the outcomes can vary from asymptomatic to severe. Objective To describe the feature of patients with eosinophilia in a single center. Design Based on the electronic medical records from Yangjiang People's Hospital in China, the inpatients admitted between June 2018 and February 2021 with measured blood eosinophil counts were evaluated. Methods Eosinophilia was defined as a peripheral blood eosinophil count of ≥0.5 × 109/L. Differences were compared by eosinophilia severity. The medical records of patients with moderate to severe eosinophilia were reviewed and summarized in terms of examination, diagnoses and management. And these patients were matched with patients without incidental eosinophilia by propensity score and the differences were compared. Results A total of 7,835 patients with eosinophilia were identified out of 131,566 total inpatients. All types of eosinophilia were most common in males (8.2%; 5,351/65,615), and in patients aged 0-6 years (11.6%; 1,760/15,204), and in the pediatric (10.8%; 1,764/16,336) department, followed by dermatology (10.6%; 123/1,162), Oncology (7.5%; 394/5,239) and Intensive care unit (ICU) (7.4%; 119/1,608). Patients with moderate to severe eosinophilia were more likely to admit to ICU (moderate: 1.3%; severe: 0.50%). In patients with moderate to severe eosinophilia, only 205/621 (33%) had eosinophilia mentioned in their records, and only 63/621 (10.1%) underwent investigations for eosinophilia. The majority of patients with moderate to severe eosinophilia (372/621, 59.9%) had an infectious disease, and little examination (7.4%; 46/621) was taken to identify the cause of eosinophilia, and only 39/621 (6.3%) of patients had a discrete cause of eosinophilia identified. Patients with moderate to severe eosinophilia (24.3%; 151/621) exhibited certain chance to have organ dysfunction. Conclusion Incidental eosinophilia in inpatients was frequently neglected and less investigated. Multidisciplinary consultation may improve outcomes of inpatients with moderate to severe eosinophilia.
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Affiliation(s)
- Bigui Chen
- Department of Respiratory and Critical Care Medicine, Yangjiang People's Hospital, Yangjiang, Guangdong, China
| | - Qiuping Rong
- Department of Respiratory and Critical Care Medicine, Yangjiang People's Hospital, Yangjiang, Guangdong, China
| | - Yu Fu
- Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Hanwen Liang
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xuetao Kong
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Qingling Zhang
- Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Mei Jiang
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Corresponding author. National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, Guangdong, 510120, China.
| | - Zhufeng Wang
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Corresponding author. National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, Guangdong, 510120, China. ;
| | - Jiaxing Xie
- Department of Respiratory and Critical Care Medicine, Yangjiang People's Hospital, Yangjiang, Guangdong, China
- Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Corresponding author. Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, Guangdong, 510120, China.
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Ness TE, Erickson TA, Diaz V, Grimes AB, Rochat R, Anvari S, Hajjar J, Weatherhead J. Pediatric Eosinophilia: A Review and Multiyear Investigation into Etiologies. J Pediatr 2023; 253:232-237.e1. [PMID: 36195311 DOI: 10.1016/j.jpeds.2022.09.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To identify the etiology of peripheral eosinophilia in a large pediatric population and to develop a diagnostic algorithm to help guide diagnosis and management of peripheral eosinophilia in the outpatient pediatric population. STUDY DESIGN We performed a retrospective chart review of children presenting to Texas Children's Hospital in Houston with peripheral eosinophilia between January 1, 2011 and December 31, 2019. Eosinophilia was classified as mild (absolute eosinophil count [AEC] >500 and <1500 cells/μL), moderate (AEC >1500 and <4500 cells/μL), or severe (AEC >4500 cells/μL). Demographic information and diagnostic workup data were collected. RESULTS A total of 771 patients aged <18 years were evaluated. The most common cause of eosinophilia was allergy (n = 357; 46%), with atopy (n = 296) and drug reaction (n = 54) the most common subcauses. This was followed by unknown etiology (n = 274; 36%), infectious causes (n = 72; 9%), and eosinophilic disorders (n = 47; 6%). Many patients with an unknown cause (n = 202; 74%) had limited or no follow-up testing. CONCLUSIONS More information on the etiology of pediatric eosinophilia and workup data could help identify the causes. This study provides important information on the evaluation of eosinophilia in the US pediatric population, including a diagnostic algorithm to guide primary care pediatricians.
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Affiliation(s)
- Tara E Ness
- Division of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
| | - Timothy A Erickson
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Veronica Diaz
- Division of Allergy and Immunology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Amanda B Grimes
- Division of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Ryan Rochat
- Division of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Sara Anvari
- Division of Allergy and Immunology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Joud Hajjar
- Division of Allergy and Immunology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Jill Weatherhead
- Division of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, TX; Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX; Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX; National School of Tropical Medicine, Baylor College of Medicine, Houston, TX
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10
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Chen B, Fu Y, Wang Z, Rong Q, Zhang Q, Xie J, Kong X, Jiang M. Eosinophilia attention, diagnosis, treatment, and awareness in physicians: a cross-sectional survey. Ther Adv Chronic Dis 2023; 14:20406223221146938. [PMID: 36712467 PMCID: PMC9880572 DOI: 10.1177/20406223221146938] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 12/05/2022] [Indexed: 01/26/2023] Open
Abstract
Background Patients with incidental eosinophilia is becoming increasingly common in clinical practice. But it remains challenging to diagnose and treat owing to its complex etiology. The awareness of physicians and the strategies of diagnosis and treatment toward eosinophilia are still unclear. Objective We aimed to evaluate attention, diagnosis, treatment, and awareness of eosinophilia among physicians, as well as factors influencing clinical practice, and to find ways to improve the efficacy of this disease. Design This is a cross-sectional survey. Methods A cross-sectional study was conducted from 1 to 4 June 2021 in a tertiary hospital. Self-administered and validated electronic questionnaire was used to investigate the attention toward eosinophilia, the strategies of diagnosis and treatment, and the awareness in physicians. Results A total of 607 valid questionnaires were collected, with a response rate of 84.5%. Among the responders, 65.4% of physicians claimed to be familiar with patients with eosinophilia but only 11.0% of them had read the relevant guidelines or expert consensus. Among 207 physicians who had ever diagnosed patients with eosinophilia, only 19.4% had performed detailed examinations. The accuracy of awareness questions was 1.6-53.5%, and only 26.5% of physicians had high levels of awareness. An increase in the awareness level of up to 2.82 folds was seen among physicians with factors such as job title, encountering patients with eosinophilia, linking patients' conditions to peripheral blood eosinophil count, and paying attention to guidelines. Conclusion This study highlighted the importance of raising awareness and knowledge of eosinophilia among physicians in China. More works on education about eosinophilia guideline are needed, which may help physicians make decision with more benefits to patients.
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Affiliation(s)
| | | | | | - Qiuping Rong
- Department of Respiratory and Critical Care
Medicine, Yangjiang People’s Hospital, Yangjiang, China
| | - Qingling Zhang
- Pulmonary and Critical Care Medicine, Guangzhou
Institute of Respiratory Health, National Clinical Research Center for
Respiratory Disease, National Center for Respiratory Medicine, State Key
Laboratory of Respiratory Diseases, The First Affiliated Hospital of
Guangzhou Medical University, Guangzhou, China
| | - Jiaxing Xie
- Department of Allergy and Clinical Immunology,
National Clinical Research Center for Respiratory Disease, State Key
Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory
Health, The First Affiliated Hospital of Guangzhou Medical University, 151
Yanjiang Road, Guangzhou 510120, China. Department of Respiratory and
Critical Care Medicine, Yangjiang People’s Hospital, Yangjiang, China
| | | | - Mei Jiang
- National Clinical Research Center for
Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou
Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou
Medical University, 151 Yanjiang Road, Guangzhou, China
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Allen J, Rajbhandari P, Schroer B. Systemic Sclerosis and Hypereosinophilic Syndrome in a 3-Year-Old Child. Ann Allergy Asthma Immunol 2022; 129:548-551. [PMID: 35995101 DOI: 10.1016/j.anai.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Jennifer Allen
- Akron Children's Hospital, One Perkins Square, Akron, OH.
| | | | - Brian Schroer
- Akron Children's Hospital, One Perkins Square, Akron, OH
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12
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Urrea Pineda LY, Perilla O, Santiago-Pacheco V, Trujillo Montoya S. Myeloproliferative Syndrome With Eosinophilia Associated With Translocation t(8; 13) and T-cell Lymphoblastic Lymphoma: A Case Report and Review of the Literature. Cureus 2022; 14:e22734. [PMID: 35386486 PMCID: PMC8969320 DOI: 10.7759/cureus.22734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/19/2022] Open
Abstract
The 8p11 myeloproliferative syndrome (EMS) is an aggressive neoplasm associated with chromosomal translocations involving the fibroblast growth factor receptor 1 tyrosine kinase gene on chromosome 8p11. We report the case of a 31-year-old man with no prior medical history who presents with two weeks of sore throat and cervical lymphadenopathy up to 5 cm. Initial peripheral blood examination showed leukocytosis with predominantly neutrophils and eosinophilia. A CT scan demonstrated mediastinal lymphadenopathies, liver enlargement and splenomegaly. An excisional biopsy of a cervical lymph node demonstrated findings consistent with a diagnosis of T-cell lymphoblastic lymphoma. Bone marrow aspirate and biopsy revealed hypercellular marrow with granulocytic predominance, left-shifted granulopoiesis, eosinophilia and the cytogenetic analysis showed the following karyotype: 46, XY, t(8;13). The final diagnosis was a myeloproliferative syndrome with eosinophilia related to t(8;13) and T-cell acute lymphoblastic lymphoma (8p11 myeloproliferative syndrome). We review the relevant literature about this unusual entity.
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Ferrão D, Silva C, Almeida JS. Pulmonary Adenocarcinoma Presenting as Acute Heart Failure and Hypereosinophilia. Cureus 2022; 14:e21441. [PMID: 35223226 PMCID: PMC8860715 DOI: 10.7759/cureus.21441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 11/05/2022] Open
Abstract
Hypereosinophilia is a serum eosinophil count of over 1,500 eosinophils/µL. It is an uncommon laboratory finding, and it can be asymptomatic or associated with organ damage, in which case it is referred to as hypereosinophilic syndrome. It can be primary, when the expansion of eosinophils occurs in the setting of a hematological neoplasm, or secondary, when it is caused by an external stimulus, such as a parasitic infection or a solid neoplasm. We present a case of hypereosinophilia diagnosed in a patient presenting with acute heart failure initially attributed to coronary disease and alcohol consumption. Due to persisting eosinophilia with no apparent cause, eventually reaching more than 41,000 eosinophils/µL, a full-body scan was performed, showing the presence of a peri-hilar mass partially obstructing the left main bronchus and multiple lesions in the liver and thoracic vertebrae. The liver biopsy revealed metastatic non-small cell lung carcinoma. Around the time the biopsy was performed, the patient began complaining of new-onset chest paint, and the diagnoses of pulmonary embolism and later lung abscess were made, the reasons why he had no conditions to begin chemotherapy. The medical condition of the patient deteriorated in the next few days, and the patient died six months after the initial diagnosis of hypereosinophilia.
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Arpáš T, Doubek M. Differential diagnosis of leukocytosis and leukopenia. VNITRNI LEKARSTVI 2022; 68:28-35. [PMID: 36402557 DOI: 10.36290/vnl.2022.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The blood cell count is often examined in routine clinical praxis. Physiologic leucocyte count is in range 4-10 × 109 in liter of blood. Abnormal values of leukocytes and subtypes of leukocytes in differential count are often present. Changes in leukocytes counts are caused by variety of benignant or malignant conditions. It is important in clinical praxis to interpret changes in blood cell count correctly and choose adequate approach in investigation process. In general, leukocytosis and leukocytopenia may present in primary hematologic disorder or secondary/reactive states, caused by reaction of hematopoiesis to underlying condition. This article review common causes of leukocytosis or leucopenia and give basic advice how to investigate patients with changes in leukocytes count.
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Wardlaw AJ, Wharin S, Aung H, Shaffu S, Siddiqui S. The causes of a peripheral blood eosinophilia in a secondary care setting. Clin Exp Allergy 2021; 51:902-914. [PMID: 34080735 DOI: 10.1111/cea.13889] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/23/2021] [Accepted: 04/09/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND A peripheral blood eosinophilia of greater than 1.0 × 109 /L is relatively unusual and offers a clue to the underlying diagnosis. In 2003, we established a specialist service to diagnose unexplained eosinophilia. OBJECTIVE To describe the causes of an eosinophilia in our service and the diagnostic algorithm we developed. METHODS Subjects were referred by physician colleagues across a range of specialties and undertook standard investigations following a semi-structured protocol. Data were extracted from a bespoke database. RESULTS Three hundred and eighty two subjects were referred over a 17-year period. Average age was 54 years and 183 (48%) of subjects were female, with 21 of 25 (84%) females in the idiopathic eosinophilic pneumonia group (p < 0001), 22 of 30 (73%) females in the gastrointestinal disease group (p < .008), but 11 of 37 (30%) females in the eosinophilic granulomatosis with polyangiitis group (p < .04). A diagnosis was assigned after systematic evaluation using a pre-defined algorithm in 361 (94.5%) of cases. Fungal allergy (82 subjects: 21%), parasitic infection (61 subjects: 16%) and severe eosinophilic asthma (50 subjects: 13%) were the three commonest individual diagnoses. Hypereosinophilic syndrome (HES) disease including eosinophilic granulomatosis with polyangiitis (EGPA) accounted for 85 subjects (20%) of which seven subjects (2%) had myeloproliferative disease (M-HES). A high IgE was common, and 79 (91%) of subjects with complete data who had an IgE of ≥1000 IU/L had fungal allergy or parasite infection. The serum tryptase was raised in 44 of 302 (14.5%) of individuals across all diagnostic groups, though none had mastocytosis. CONCLUSION A diagnosis of an unexplained eosinophilia can usually be determined using as semi-structured algorithm. Parasitic infection and fungal allergy often with severe eosinophilic asthma were common causes, whereas HES, particularly myeloproliferative, disease was relatively rare.
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Affiliation(s)
- Andrew John Wardlaw
- Department of Respiratory Sciences, College of Life Sciences, Institute for Lung Health, NIHR Leicester Biomedical Research Centre (Respiratory theme), University of Leicester and Respiratory and Allergy Services, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sarah Wharin
- Department of Haematology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Hnin Aung
- Department of Respiratory Sciences, College of Life Sciences, Institute for Lung Health, NIHR Leicester Biomedical Research Centre (Respiratory theme), University of Leicester and Respiratory and Allergy Services, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Shireen Shaffu
- Department of Rheumatology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Salman Siddiqui
- Department of Respiratory Sciences, College of Life Sciences, Institute for Lung Health, NIHR Leicester Biomedical Research Centre (Respiratory theme), University of Leicester and Respiratory and Allergy Services, University Hospitals of Leicester NHS Trust, Leicester, UK
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Kelemen K, Saft L, Craig FE, Orazi A, Nakashima M, Wertheim GB, George TI, Horny HP, King RL, Quintanilla-Martinez L, Wang SA, Rimsza LM, Reichard KK. Eosinophilia/Hypereosinophilia in the Setting of Reactive and Idiopathic Causes, Well-Defined Myeloid or Lymphoid Leukemias, or Germline Disorders. Am J Clin Pathol 2021; 155:179-210. [PMID: 33367563 DOI: 10.1093/ajcp/aqaa244] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To report the findings of the 2019 Society for Hematopathology/European Association for Haematopathology Workshop within the categories of reactive eosinophilia, hypereosinophilic syndrome (HES), germline disorders with eosinophilia (GDE), and myeloid and lymphoid neoplasms associated with eosinophilia (excluding entities covered by other studies in this series). METHODS The workshop panel reviewed 109 cases, assigned consensus diagnosis, and created diagnosis-specific sessions. RESULTS The most frequent diagnosis was reactive eosinophilia (35), followed by acute leukemia (24). Myeloproliferative neoplasms (MPNs) received 17 submissions, including chronic eosinophilic leukemia, not otherwise specified (CEL, NOS). Myelodysplastic syndrome (MDS), MDS/MPN, and therapy-related myeloid neoplasms received 11, while GDE and HES received 12 and 11 submissions, respectively. CONCLUSIONS Hypereosinophilia and HES are defined by specific clinical and laboratory criteria. Eosinophilia is commonly reactive. An acute leukemic onset with eosinophilia may suggest core-binding factor acute myeloid leukemia, blast phase of chronic myeloid leukemia, BCR-ABL1-positive leukemia, or t(5;14) B-lymphoblastic leukemia. Eosinophilia is rare in MDS but common in MDS/MPN. CEL, NOS is a clinically aggressive MPN with eosinophilia as the dominant feature. Bone marrow morphology and cytogenetic and/or molecular clonality may distinguish CEL from HES. Molecular testing helps to better subclassify myeloid neoplasms with eosinophilia and to identify patients for targeted treatments.
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Affiliation(s)
| | - Leonie Saft
- Department of Pathology, Karolinska University Hospital and Institute, Stockholm, Sweden
| | - Fiona E Craig
- Division of Hematopathology, Mayo Clinic, Phoenix, AZ
| | - Attilio Orazi
- Department of Pathology, Texas Tech University Health Sciences Center, El Paso
| | - Megan Nakashima
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH
| | - Gerald B Wertheim
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Tracy I George
- Department of Pathology, University of Utah School of Medicine, Salt Lake City
| | - Hans-Peter Horny
- Institute of Pathology, University of Munich (LMU), Munich, Germany
| | | | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology, Eberhard Karls University of Tübingen and Comprehensive Cancer Center, Tübingen University Hospital, Tübingen, Germany
| | - Sa A Wang
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston
| | - Lisa M Rimsza
- Division of Hematopathology, Mayo Clinic, Phoenix, AZ
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Portal vein thrombosis and food protein-induced allergic proctocolitis in a premature newborn with hypereosinophilia: a case report. BMC Pediatr 2021; 21:49. [PMID: 33485314 PMCID: PMC7825155 DOI: 10.1186/s12887-021-02510-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/18/2021] [Indexed: 01/10/2023] Open
Abstract
Background Peripheral blood eosinophilia is identified in numerous medical conditions associated with allergic, infectious, and inflammatory processes mostly as reactive eosinophilia with or without tissue eosinophilia. In hospitalized neonates, eosinophilia is common with an inverse relationship with gestational age and occurs solely as mild eosinophilia in the majority of cases. In the literature, eosinophilia has been proposed as a possible risk factor for venous thromboembolism. However, few reports are found on thromboembolic events including portal vein thrombosis (PVT) associated with eosinophilia in the newborn period. Neonates, particularly preterm infants, are vulnerable to thrombosis due to the immature and developing hemostatic system with little reserve capacity, which occurs as catheter-related thrombosis in most cases. Case presentation A male newborn at 34+ 5 weeks’ gestation presented with a left portal venous thrombus and hematochezia after initial cow’s milk feeding in the setting of blood hypereosinophilia for a prolonged period of time without central venous catheterization. The infant was diagnosed with PVT and food protein-induced allergic proctocolitis (FPIAP) and showed complete resolution of the conditions with expectant management with food avoidance, including the normalized eosinophil count. Conclusions Our experience suggests that in the setting of hypereosinophilia with a prolonged duration in premature neonates, FPIAP should be suspected in case of hematochezia in otherwise healthy infants, and considering the increased thrombotic risk by the hypereosinophilia and premature newborn status, evaluation for neonatal thrombosis may be needed, including PVT with the potential risk for the more serious, but uncommon, late complications encompassing portal hypertension.
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Hasan Albitar HA, Egan AM, Alkhateeb H, Almodallal Y, Iyer VN. Marked hypereosinophilia secondary to endometrioid ovarian cancer presenting with asthma symptoms, a case report. Respir Med Case Rep 2020; 31:101178. [PMID: 32775193 PMCID: PMC7404536 DOI: 10.1016/j.rmcr.2020.101178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022] Open
Abstract
Background Hypereosinophilia (HE) is defined by the presence of >1.5 × 109/L eosinophils in the peripheral blood. Paraneoplastic HE has been reported in a number of solid and hematologic malignancies including ovarian cancer. We present a case with paraneoplastic HE in the setting of underlying endometrioid ovarian carcinoma. Case presentation An 88-year-old woman presented with cough, dyspnea and 20-pound unintentional weight loss of one month duration. Evaluation revealed peripheral hypereosinophilia (HE) with absolute eosinophil count of 15.38 × 109/L (53.8%) and an elevated exhaled nitric oxide at 172 parts per billion (normal < 39 PPB). Given the HE and unintentional weight loss, computed tomography (CT) scan was obtained and showed a pelvic mass. The patient underwent bilateral salpingo-ophorectomy with pathology consistent with endometrioid ovarian carcinoma. The patient experienced complete resolution of her cough, dyspnea, and peripheral eosinophilia following surgical resection. Conclusion This case highlights that solid malignancy should be considered in patients with marked HE.
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Affiliation(s)
| | - Ashley M Egan
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Hassan Alkhateeb
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Vivek N Iyer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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George TI. Evolution of the International Journal of Laboratory Hematology. Int J Lab Hematol 2020; 42 Suppl 1:6-7. [DOI: 10.1111/ijlh.13203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 03/23/2019] [Indexed: 11/28/2022]
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20
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Zanelli M, Smith M, Zizzo M, Carloni A, Valli R, De Marco L, Foroni M, Palicelli A, Martino G, Ascani S. A tricky and rare cause of pulmonary eosinophilia: myeloid/lymphoid neoplasm with eosinophilia and rearrangement of PDGFRA. BMC Pulm Med 2019; 19:216. [PMID: 31744552 PMCID: PMC6862820 DOI: 10.1186/s12890-019-0967-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 10/18/2019] [Indexed: 01/21/2023] Open
Abstract
Background Eosinophilic lung diseases represent a heterogeneous group of disorders with prominent infiltrate of eosinophils in lung interstitium and alveolar spaces. Peripheral blood eosinophilia is often present. Infections, drugs, allergens, toxic agents have to be evaluated as possible causes of eosinophilic lung infiltrates. The category of myeloid/lymphoid neoplasms with eosinophilia and rearrangement of PDGFRA, PDGFRB, FGFR1 and PCM1-JAK2 represents an uncommon cause of eosinophilic lung infiltrate. Case presentation We report the case of a 70-year old man complaining of dry cough and dyspnea. Ground glass-opacities were seen on imaging studies and peripheral blood eosinophilia was present. A thorough step-wise patient’s evaluation led to identify the clonal nature of eosinophilia and the diagnosis of myeloid/lymphoid neoplasm with eosinophilia and rearrangement of PDGFRA was made. Conclusions Correlation with clinical history, laboratory tests and imaging studies is essential to achieve the correct diagnosis when facing with eosinophilic lung infiltrates. A prolonged eosinophilia can cause life-threatening organ damage. Identification of PDGFRA rearrangement, as in the present case, is particularly critical given the sensitivity and excellent response to imatinib, which has completely changed the natural history of this neoplasm.
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Affiliation(s)
- Magda Zanelli
- Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maxwell Smith
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy. .,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
| | - Angelo Carloni
- Radiology Unit, Ospedale di Terni, University of Perugia, Perugia, Italy
| | - Riccardo Valli
- Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Loredana De Marco
- Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Moira Foroni
- Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Palicelli
- Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Stefano Ascani
- Pathology Unit, Ospedale di Terni, University of Perugia, Perugia, Italy
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Troschke-Meurer S, Siebert N, Marx M, Zumpe M, Ehlert K, Mutschlechner O, Loibner H, Ladenstein R, Lode HN. Low CD4⁺/CD25⁺/CD127⁻ regulatory T cell- and high INF-γ levels are associated with improved survival of neuroblastoma patients treated with long-term infusion of ch14.18/CHO combined with interleukin-2. Oncoimmunology 2019; 8:1661194. [PMID: 31741754 PMCID: PMC6844328 DOI: 10.1080/2162402x.2019.1661194] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/25/2019] [Accepted: 08/23/2019] [Indexed: 12/22/2022] Open
Abstract
Immunotherapy with the anti-GD2 antibody (Ab) ch14.18/CHO in combination with interleukin 2 (IL-2) has improved survival of high-risk neuroblastoma (NB) patients. Here, we report immunotherapy-related effects on circulating NK cells, regulatory T cells (Tregs), granulocytes as well as on Ab-dependent cell-mediated cytotoxicity (ADCC) and cytokines IFN-γ, IL-6, IL-10, IL-18 and CCL2 and their association with progression-free survival (PFS). In a closed single-center program, 53 patients received five cycles of 6 × 106 IU/m2 subcutaneous IL-2 (d1-5; 8–12) combined with long-term infusion (LTI) of 100 mg/m2 ch14.18/CHO (d8-18). Immune cells and cytokines were analyzed by flow cytometry and ADCC by calcein-AM-based cytotoxicity assay. IL-2 administration increased cytotoxic NK cell-, eosinophil- and Treg counts in cycle 1 (2.9-, 3.1- and 20.7-fold, respectively) followed by further increase in subsequent cycles, whereas neutrophil levels were elevated only after the ch14.18/CHO infusion (2.4-fold change). Serum concentrations of IFN-γ, IL-6, IL-10, IL-18 and CCL2 in cycle 1 were increased during the combinatorial therapy (peak levels of 3,656 ± 655 pg/ml, 162 ± 38 pg/ml, 20.91 ± 4.74 pg/ml, 1,584 ± 196 pg/ml and 2,159 ± 252 pg/ml, respectively). Surprisingly, we did not observe any correlation between NK-, eosinophil- or neutrophil levels and PFS. In contrast, patients with low Tregs showed significantly improved PFS compared to those who had high levels. Treg counts negatively correlated with INF-γ serum concentrations and patients with high INF-γ and IL-18 had significantly improved survival compared to those with low levels. In conclusion, LTI of ch14.18/CHO in combination with IL-2 resulted in Treg induction that inversely correlated with IFN-γ levels and PFS.
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Affiliation(s)
- Sascha Troschke-Meurer
- Department of Pediatric Oncology and Hematology, University Medicine Greifswald, Greifswald, Germany
| | - Nikolai Siebert
- Department of Pediatric Oncology and Hematology, University Medicine Greifswald, Greifswald, Germany
| | - Madlen Marx
- Department of Pediatric Oncology and Hematology, University Medicine Greifswald, Greifswald, Germany
| | - Maxi Zumpe
- Department of Pediatric Oncology and Hematology, University Medicine Greifswald, Greifswald, Germany
| | - Karoline Ehlert
- Department of Pediatric Oncology and Hematology, University Medicine Greifswald, Greifswald, Germany
| | | | | | - Ruth Ladenstein
- St. Anna Children's Hospital and Children's Cancer Research Institute (CCRI), Department of Pediatrics, Medical University, Vienna, Austria
| | - Holger N Lode
- Department of Pediatric Oncology and Hematology, University Medicine Greifswald, Greifswald, Germany
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22
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Tappia PS, Maksymiuk AW, Sitar DS, Akhtar PS, Khatun N, Parveen R, Ahmed R, Ahmed RB, Cheng B, Huang G, Bach H, Hiebert B, Ramjiawan B. Predictive value and clinical significance of increased SSAT-1 activity in healthy adults. Future Sci OA 2019; 5:FSO400. [PMID: 31428447 PMCID: PMC6695528 DOI: 10.2144/fsoa-2019-0023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/24/2019] [Indexed: 12/12/2022] Open
Abstract
AIM Spermidine/spermine N1-acetyltransferase (SSAT-1) regulates cell growth, proliferation and death. Amantadine is converted by SSAT-1 to acetylamantadine (AA). In our earlier studies, although SSAT-1 was activated in patients with cancer, a number of ostensibly healthy adult volunteers had higher than expected AA concentration. This study was therefore undertaken to examine the outlier group. MATERIALS & METHODS A follow up of urine analysis for AA by liquid chromatography-tandem mass spectrometry as well as clinical assessments and additional blood analyses were conducted. RESULTS In some of the outlier controls, higher than expected AA concentration was linked to increased serum carcinoembryonic antigen. Clinical and radiographic assessments revealed underlying abnormalities in other cases that could represent premalignant conditions. Hematology tests revealed elevations in white blood cells and platelets, which are markers of inflammation. CONCLUSION High urine concentration of AA could be used as a simple and useful test for screening of cancer in high-risk populations.
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Affiliation(s)
- Paramjit S Tappia
- Asper Clinical Research Institute & Office of Clinical Research, St Boniface Hospital, Winnipeg, MB, R2H 2A6, Canada
| | - Andrew W Maksymiuk
- Cancer Care Manitoba, Winnipeg, MB, R3E 0V9, Canada
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3A 1R9, Canada
| | - Daniel S Sitar
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3A 1R9, Canada
- Department of Pharmacology & Therapeutics, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0T5, Canada
| | - Parveen S Akhtar
- Department of Medical Oncology, National Institute of Cancer Research & Hospital, Mohakhali, Dhaka, Bangladesh
| | - Nazrina Khatun
- Department of Medical Oncology, National Institute of Cancer Research & Hospital, Mohakhali, Dhaka, Bangladesh
| | - Rahnuma Parveen
- Department of Medical Oncology, National Institute of Cancer Research & Hospital, Mohakhali, Dhaka, Bangladesh
| | | | | | - Brian Cheng
- BioMark Diagnostics Inc., Richmond, BC, V6X 2W8, Canada
| | - Gina Huang
- BioMark Diagnostics Inc., Richmond, BC, V6X 2W8, Canada
| | - Horacio Bach
- Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, Vancouver, BC, V5Z 3J5, Canada
| | - Brett Hiebert
- Cardiac Sciences Program, Asper Clinical Research Institute, Winnipeg, MB, R2H 2A6, Canada
| | - Bram Ramjiawan
- Asper Clinical Research Institute & Office of Clinical Research, St Boniface Hospital, Winnipeg, MB, R2H 2A6, Canada
- Department of Pharmacology & Therapeutics, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0T5, Canada
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