Blood eosinophilia: A new paradigm in disease classification, diagnosis, and treatment

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Abstract

Acquired blood eosinophilia is considered either a primary or a secondary phenomenon. Causes of secondary (ie, reactive) eosinophilia include tissue-invasive parasitosis, allergic or inflammatory conditions, and malignancies in which eosinophils are not considered part of the neoplastic process. Primary eosinephilia is classified operationally into 2 categories: clonal and idiopathic. Clonal eosinophilia stipulates the presence of either cytogenetic evidence or bone marrow histological evidence of an otherwise classified hematologic malignancy such as acute leukemia or a chronic myeloid disorder. Idiopathic eosinophilia is a diagnosis of exclusion (ie, not secondary or clonal). Hypereosinophilic syndrome is a subcategory of idiopathic eosinophilia; diagnosis requires documentation of both sustained eosinophilia (absolute eosinophil count ≥1500 cells/μL for at least 6 months) and target organ damage (eg, involvement of the heart, lung, skin, or nerve tissue). Genetic mutations involving the platelet-derived growth factor receptor genes (PDGFR-α and PDGFR-β) have been pathogenetically linked to clonal eosinophilia, and their presence predicts treatment response to imatinib. Accordingly, cytogenetic and/or molecular investigations for the presence of an imatinib-sensitive molecular target should accompany current evaluation for primary eosinophilia. In the absence of such a drug target, specific treatment is dictated by the underlying hematologic malignancy in cases of clonal eosinophilia; however, the initial treatment of choice for symptomatic patients with hypereosinophilic syndrome is prednisone and/or interferon alfa.

Original languageEnglish (US)
Pages (from-to)75-83
Number of pages9
JournalMayo Clinic Proceedings
Volume80
Issue number1
StatePublished - 2005

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Eosinophilia
Hypereosinophilic Syndrome
Therapeutics
Hematologic Neoplasms
Eosinophils
Cytogenetics
Neoplastic Processes
Platelet-Derived Growth Factor Receptors
Nerve Tissue
Prednisone
Interferon-alpha
Documentation
Leukemia
Cell Count
Bone Marrow
Lung
Skin
Mutation

ASJC Scopus subject areas

  • Medicine(all)

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Blood eosinophilia : A new paradigm in disease classification, diagnosis, and treatment. / Tefferi, Ayalew.

In: Mayo Clinic Proceedings, Vol. 80, No. 1, 2005, p. 75-83.

Research output: Contribution to journalArticle

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