Isochromosome 17 in a patient with a myeloproliferative disorders terminating in eosinophilic leukemia

A patient is described, who for more than two years had a myeloproliferative disorder which terminated in eosinophilic leukemia. Chromosome analysis revealed an isochromosome 17 in all metaphases of bone marrow cells. This abnormality has now been found in two out of six patients with eosinophilic leukemia investigated by banding techniques, and may therefore have etiologic importance. Chromosome analysis in the hypereosinophilic syndrome has practical value for differentiating malignant and non-malignant disease.

Prognostic value of mitotic studies in myeloid leukaemias

Seven patients with various forms of myeloid leukaemia have been studied by repeated sternal punctures during the course of illness. None of the patients received cytostatics before or during the study. The mitotic indices declined with time and there was a significant relation between the slopes of the mitotic curves and survival time. Repeated mitotic counts seem to serve as a diagnostic and prognostic tool in myeloid leukaemias.

Different composition of the eosinophilic bone marrow pool in reactive eosinophilia and eosinophilic leukaemia

The composition of the eosinophilic cell series in the bone marrow has been analysed in 10 patients with a pronounced reactive eosinophilia (RE) and in 2 with eosinophilic leukaemia (EL). An imparied differentiation of the eosinophils was found in the EL patients compared with the RE group. Thus the ratio of eosinophilic promyelocytestmyelocytes: segmented eosinophils was 9.2 and 9.1, respectively, in the patients with EL and 0.1--3.1 (average 1.3) in the RE patients. It is suggested that EL is characterized by an impaired differentiation of the eosinophilic bone marrow cells and that the recognition of this abnormality is of value in the diffential diagnosis between EL and RE.

WT1 transcript amount discriminates secondary or reactive eosinophilia from idiopathic hypereosinophilic syndrome or chronic eosinophilic leukemia

Idiopathic hypereosinophilic syndromes (HES) comprise a spectrum of indolent to aggressive diseases characterized by persistent hypereosinophilia. Hypereosinophilia can result from the presence of a defect in the hematopoietic stem cell giving rise to eosinophilia, it can be present in many myeloproliferative disorders or alternatively it may be a reactive form, secondary to many clinical conditions. The hybrid gene FIP1L1-PDGRFalpha was identified in a subset of patients presenting with HES or chronic eosinophilic leukemia (CEL). In spite of this, the majority of HES patients do not present detectable molecular lesions and for many of them the diagnosis is based on exclusion criteria and sometimes it remains doubt. In this study we explored the possibility to distinguish between HES/CEL and reactive hypereosinophilia based on WT1 transcript amount. For this purpose, 312 patients with hypereosinophilia were characterized at the molecular and cytogenetic level and analyzed for WT1 expression at diagnosis and during follow-up. This study clearly demonstrates that WT1 quantitative assessment allows to discriminate between HES/CEL and reactive eosinophilia and represents a useful tool for disease monitoring especially in the patients lacking a marker of clonality.

Eosinophilia: secondary, clonal and idiopathic

Blood eosinophilia signifies either a cytokine-mediated reactive phenomenon (secondary) or an integral phenotype of an underlying haematological neoplasm (primary). Secondary eosinophilia is usually associated with parasitosis in Third World countries and allergic conditions in the West. Primary eosinophilia is operationally classified as being clonal or idiopathic, depending on the respective presence or absence of a molecular, cytogenetic or histological evidence for a myeloid malignancy. The current communication features a comprehensive clinical summary of both secondary and primary eosinophilic disorders with emphasis on recent developments in molecular pathogenesis and treatment.

Molecular classification and pathogenesis of eosinophilic disorders: 2005 update

Use of the term "idiopathic hypereosinophilic syndrome (HES)" has highlighted our basic lack of understanding of the molecular pathophysiology of eosinophilic disorders. However, over the last 10 years, the study of hypereosinophilia has enjoyed a revival. This interest has been rekindled by two factors: (1) the development of increasingly sophisticated molecular biology techniques that have unmasked recurrent genetic abnormalities linked to eosinophilia, and (2) the successful application of targeted therapy with agents such as imatinib to treat eosinophilic diseases. To date, most of these recurrent molecular abnormalities have resulted in constitutively activated fusion tyrosine kinases whose phenotypic consequence is an eosinophilia-associated myeloid disorder. Most notable among these are rearrangements of platelet-derived growth factor receptors alpha and beta (PDGFRalpha, PDGFRbeta), which define a small subset of patients with eosinophilic chronic myeloproliferative disorders (MPDs) and/or overlap myelodysplastic syndrome/MPD syndromes, including chronic myelomonocytic leukemia. Discovery of the cryptic FIP1L1-PDGFRA gene fusion in cytogenetically normal patients with systemic mast cell disease with eosinophilia or idiopathic HES has redefined these diseases as clonal eosinophilias. A growing list of fibroblast growth factor receptor 1 fusion partners has similarly emerged in the 8p11 myeloproliferative syndromes, which are often characterized by elevated eosinophil counts. Herein the focus is on the molecular gains made in these MPD-type eosinophilias, and the classification and clinicopathological issues related to hypereosinophilic syndromes, including the lymphocyte variant. Success in establishing the molecular basis of a group of once seemingly heterogeneous diseases has now the laid the foundation for establishing a semi-molecular classification scheme of eosinophilic disorders.

Chronic eosinophilic leukemia and hypereosinophilic syndromes. Proposal for classification, literature review, and report of a case with a unique chromosomal abnormality

The idiopathic hypereosinophilic syndromes (HES) are rare hematologic disorders characterized by persistent eosinophilia with organ involvement that encompass a wide spectrum of clinical and hematological disease states. We propose a classification scheme to further delineate these patients, and present a case of a 45-year-old male with persistent eosinophilia, severe tissue and hematologic involvement, and trisomy 15. Although multiple cytogenetic abnormalities have been associated with hypereosinophilic syndromes, this is the first reported case where trisomy 15 is the sole chromosomal abnormality.

Eosinophilic leukaemia with trisomy 8 and double gammopathy

Prolonged eosinophilia of unknown cause has generally been described as the hypereosinophilic syndrome, and is characterised by peripheral blood and bone marrow infiltration and frequent multisystem disease. The nature of this disorder has been questioned, and the clinical features are quite variable, suggesting its heterogeneity and probable neoplastic aetiology. A patient with severe eosinophilia, karyotype abnormalities, serum gammopathy and massive organ disease is reported. The clinical course was aggressive despite cytoreduction of eosinophils and terminated in multisystem failure. These findings are consistent with a diagnosis of eosinophilic leukaemia, and it is suggested that chromosome and cell culture studies might be useful in the early diagnosis of this controversial entity.

Myelofibrosis in a child suffering from a hypereosinophilic syndrome with trisomy 8: response to corticotherapy

The idiopathic hypereosinophilic syndrome (IHS) is extremely rare in childhood and relationships of this syndrome with myeloproliferative diseases are controversial. We reported the observation of a 7-year-old girl suffering from an IHS with myelofibrosis. A clonal cytogenetic abnormality, trisomy 8, was detected in the bone marrow cells of this child. This is the decisive proof of a myeloproliferative disorder. IHS with myelofibrosis is usually considered as unresponsive to corticotherapy. In our case, corticotherapy resulted in a rapid, complete, and lasting disappearance of myelofibrosis. Complete remission of the disease, however, was not achieved and the trisomy 8 persisted after treatment.

Abnormalities of chromosome 12p13 and malignant proliferation of eosinophils: a nonrandom association

Four patients representing a spectrum of haematological malignancies are reported. Two patients had Philadelphia chromosome negative myeloproliferative disorders, one had acute lymphoblastic leukaemia and one had eosinophilic leukaemia. In each case eosinophilia was present and demonstrated to be part of the malignancy by the association of clonally abnormal metaphases with eosinophil granules. Abnormalities involving the short arm of chromosome 12 (12p13) were a constant feature in all four cases and therefore a nonrandom association between this chromosome region and malignant eosinophil proliferation is proposed.

Unusual chromosome 7 aberrations in a case of eosinophilic myeloproliferative syndrome

A patient with myeloproliferative syndrome with marked eosinophilia was found to have unusual karyotypic abnormalities, including monosomy for the short arm and part of the long arm of chromosome #7 in cultured bone marrow cells. These abnormalities have never been reported previously. The role of chromosome #7 deletions in the genesis of leukemic disorders is discussed.

Acute eosinophilic leukemia with a translocation (10p+;11q-)

Eosinophilic leukemias are difficult to individualize amid the hypereosinophilic syndromes. Chromosomal abnormalities when present within the eosinophils are of critical value in the diagnosis of a malignancy. We report here the case of a 27-year-old woman who had been healthy, until recently when she suddenly developed hepatosplenomegaly and lymph node enlargement, and considerable eosinophilia in blood and bone marrow. The morphologically abnormal cells (large pseudo Pelger eosinocytes) predominated in the cytology. The establishment in these cells of a clonal chromosomal anomaly, t(10;11)(p14;q21), favored the malignancy and diagnosis of acute eosinophilic leukemia.

Chromosome and cell culture studies in eosinophilic leukaemia

A cytogenetic analysis was carried out on bone marrow cells from 11 patients who presented with hypereosinophilia and the clinical features of the idiopathic hypereosinophilic syndrome. One of these patients was found to have trisomy 8 affecting the myeloid series, including eosinophils. In this patient, marrow eosinophils also showed asynchrony of nuclear-cytoplasmic maturation, and there were increased numbers of myeloid progenitor cells in the blood. Six months later, blast cell transformation occurred, and he died soon afterwards. These findings show that abnormalities in the karyotype of bone marrow cells and culture of blood progenitor cells may help to identity eosinophilic leukaemia among patients who present with features of the idiopathic hypereosinophilic syndrome.

Acute nonlymphocytic leukemia with eosinophilic differentiation

Four cases of de novo acute nonlymphocytic leukemia (ANLL) with early eosinophilic differentiation are described. The clinical course did not differ from that of the usual forms of ANLL. Morphologic and cytochemical features that can support this diagnosis are discussed. Particularly, the cyanide-resistant peroxidase stain appeared to be a specific marker of eosinophilic differentiation. Acute eosinophilic leukemia is a distinct entity, and this unusual subtype of ANLL can be set apart from other forms of ANLL characterized by hypereosinophilia.

Evolution to eosinophilic leukemia with a t(5:11) translocation in a patient with idiopathic hypereosinophilic syndrome

The idiopathic hypereosinophilic syndrome (HES) comprises a diverse group of diseases that may ultimately lead to multiorgan dysfunction and death. We present a case of a man who was followed for over 9 years with HES that underwent malignant transformation to acute leukemia with eosinophilic features. The patient's clinical acceleration was accompanied by the development of a malignant clone that was identified with banding techniques as 46,XY,t(5:11)(p15;q13). Electron microscopy reaffirmed findings reported in earlier cases of eosinophilic leukemia. At no time during his illness were cytotoxic drugs administered. In addition to delineating the natural evolution and cytostructural details of the case, we emphasize the role of cytogenetics in the predicting of malignant variants of the hypereosinophilic syndrome and in identifying eosinophilic leukemia.

Association of an inversion of chromosome 16 with abnormal marrow eosinophils in acute myelomonocytic leukemia. A unique cytogenetic-clinicopathological association

We identified 18 patients with an inversion of chromosome 16, inv(16)(p13q22), among 308 patients with newly diagnosed acute nonlymphocytic leukemia. Each of these 18 patients had acute myelomonocytic leukemia (M4 subtype) and eosinophils with distinctly abnormal morphology, cytochemical staining, and ultrastructure. These eosinophils constituted from 1 to 33 per cent of the nucleated marrow cells. In our series, every patient with acute myelomonocytic leukemia and abnormal eosinophils also had an abnormal chromosome 16. This subgroup of M4 patients had a good response to intensive therapy designed to induce remission; 13 of 17 treated patients entered a complete remission, and 10 remain in first remission. Thus, patients with an inversion of chromosome 16 appear to represent a unique cytogenetic-clinicopathological subtype of acute nonlymphocytic leukemia with a favorable prognosis.

Micronuclei in erythropoietic bone marrow cells: relation to cytogenetic pattern and prognosis in acute nonlymphocytic leukemia

The bone marrow karyotype and the frequency of micronuclei in erythropoietic bone marrow cells (Howell-Jolly bodies) were determined in 25 adults with acute nonlymphocytic leukemia (ANLL). Ten patients had exclusively normal diploid bone marrow cells; 11 had a mixture of normal and abnormal cells, and 4 had abnormal bone marrow metaphases only. The frequency of micronuclei ranged frm 3 to 28/2000 erythropoietic bone marrow cells (median 10). The number of micronuclei was significantly higher in patients with abnormal metaphases than in those with normal metaphases; in patients with a mixture of normal and abnormal bone marrow metaphases there was an association between the frequency of abnormal metaphases and the number of micronuclei. A striking difference in median survival time was found between patients with low and high numbers of micronuclei, irrespective of the cytogenetic bone marrow patterns. Patients with fewer than 10 micronuclei per 2000 erythropoietic bone marrow cells had a median survival of 148 days; those with more than 10/2000 had a median survival of only 34 days (0.002 less than p less than 0.02).

Three or four copies of a dicentric 17q isochromosome in an acute myeloproliferative disorder

The majority of metaphases in the bone marrow of a male patient aged 72 with a rapidly evolving aleukemic erythremic myelosis had 48 chromosomes with three copies, or 49 chromosomes with four copies, of an i(17q), which was seen to be dicentric in C-banded and Giemsa-11-banded preparations. There was also loss of a chromosome No. 5 and the addition of a chromosome resembling a No. 22. The presence of multiple copies of the isochromosome is postulated to be related to the acuteness of the condition.

Chromosomes and causation of human cancer and leukemia. XXXIV. A case of "hypereosinophilic syndrome" with unusual cytogenetic findings in a chloroma, terminating in blastic transformation and CNS leukemia

A 47-year-old white male developed massive hepatosplenomegaly, a pleural effusion, leucocytosis, and a left parasternal mass following a relatively symptom-free persistent hypereosinophilia for about 5 years. Bone marrow aspiration and biopsy and peripheral blood differential showed eosinophilia and a shift to the left with immature cells. A high serum B12 vitamin level and low LAP activity were found. Biopsy of the soft tissue mass revealed a granulocytic sarcoma (chloroma) with a hyperdiploid karyotype (49,XY, + 10, + 15, + 19,3q-), whereas the bone marrow cells had a normal male karyotype. The patient responded temporarily to chemotherapy but eventually developed CNS leukemia and went on to terminate in a frank blastic phase. This case illustrates hypereosinophilia and a myeloproliferative syndrome characterized by a somewhat indolent chronic course evolving into "eosinophilic leukemia" and granulocytic sarcoma, CNS involvement by leukemic cells and, finally, blastic transformation. It is possible that this case represents a variant of Ph1-negative CML to which the term "chronic eosinophilic leukemia" could be justifiably applied.

Eosinophilia, chloromas and a chromosome abnormality in a patient with a myeloproliferative syndrome

The existence of eosinophilic leukemia remains controversial since many authors challenge the existence of this entity. We present a patient with a hypereosinophilic syndrome whose findings were consistent with a leukemic process. The patient's course was marked my signs and symptoms of myeloblastoma formation and his illness terminated in an acute blastic crisis. chromosome studies on peripheral blood leucocytes demonstrated aneuploidy and an abnormal number four chromosome with additional material on its long arm. This case appears to be an unusual example of a hypereosinophilic syndrome with both myeloblastoma formation and an abnormal leucocyte karyotype.

Acute eosinophilo-myelomonocytic leukaemia, one of the 'in between leukaemias'

A patient is reported to have an in between type of acute myeloid leukaemia, namely acute eosinophilomyelomonocytic leukaemia. The blasts in the peripheral blood showed a definite transition towards immature monocytes. The bone marrow contained 65% blasts and 13% eosinophil promyelocytes. The large number of immature eosinophils in the bone marrow strongly support the view that they were part of the leukaemic process and not merely a reactive eosinophilia.

Chromosomal aneuploidy in a patient with hypereosinophilic syndrome. Evidence for a malignant disease

A patient with rapidly fatal hypereosinophilic syndrome and a bone marrow chromosomal abnormality, 49,XYY,t(3:5),+8,+mar, is described. Scanning and transmission electron microscopy of eosinophils failed to reveal any significant abnormalities. Previous cytogenetic data on patients with hypereosinophilic syndrome have been deficient in that few studies have been performed with banding technics. These technics may help in the classification of hypereosinophilic syndrome and predict which patients will have a rapidly fatal course.

Ph1-negative eosinophilic leukaemia with trisomy 8. Case report and review of cytogenetic studies

A case of eosinophilic leukaemia of the mature cell type in a 73-year-old man is described. Bone marrow chromosomes were studied in direct preparations on 3 occasions. With the G- and Q-banding techniques an extra chromosome number 8 was observed in all metaphases. There was no Ph1-chromosome. Therapy with vincristine and prednisone produced remissions but the course of the disease was accelerated. Review of the literature and study of the present case suggests that eosinophilic leukaemia like CGL may be divided into a Ph1-positive and a Ph1-negative group. In both groups karyotype abnormalities may be present and might herald a downhill course.

Isochromosome 17 in a case of chronic erythroleukaemia

In a patient with chronic erythroleukaemia in isochromosome 17q was identified in all bone marrow metaphases analyzed. In addition, these cells were characterized by hypodiploidy and the presence of 3 different marker chromosomes. Approximately 50% of dividing cells in the marrow were bizarre-looking polyploids. The identification by Giemsa banding of i(17q) in this case of erythroleukaemia supports the concept that there are common cytogenetic characteristics among malignant myeloproliferative disorders.

Non-random chromosome changes in acute myeloid leukemia. Chromosome banding examination of 30 cases at diagnosis

Bone-marrow chromosomes were examined with the G-banding technique in 30 patients with acute myeloid leukemia at the time of diagnosis. In 13 of the 30 patients (43%) only normal diploid bone-marrow cells were found, and no deviations from the normal banding pattern could be detected in these cells. In bone-marrow cells of 17 patients (57%), distinct chromosome abnormalities were found; in 10 of the patients only abnormal cells were observed, whereas in 7 of the patients the abnormal cells coexisted with normal diploid cells without any visible chromosome banding abnormality. The results of the detailed analysis of the karyotypic aberrations demonstrated that when chromosome aberrations occurred they were clearly non-random. All patients except two displayed trisomy 8,9 or 21 or monosomy 7. Analysis of cases of acute leukemia from other laboratories indicated that the same consistent pattern of chromosome involvement prevailed in them.