Diagnostic challenges in the work up of hypereosinophilia

• Verfasst von: Schwaab, Juliana [VerfasserIn]
• Verfasst von: Jawhar, Mohamad [VerfasserIn]
• Verfasst von: Naumann, Nicole [VerfasserIn]
• Verfasst von: Fabarius, Alice [VerfasserIn]
• Verfasst von: Hofmann, Wolf-Karsten [VerfasserIn]
• Verfasst von: Reiter, Andreas [VerfasserIn]
• Verfasst von: Metzgeroth, Georgia [VerfasserIn]
• Titel: Diagnostic challenges in the work up of hypereosinophilia
• Titelzusatz: pitfalls in bone marrow core biopsy interpretation
• Verf.angabe: Juliana Schwaab, Mohamad Jawhar, Nicole Naumann, Annette Schmitt-Graeff, Alice Fabarius, Hans-Peter Horny, Nicholas C. P. Cross, Wolf-Karsten Hofmann, Andreas Reiter, Georgia Metzgeroth
• Umfang: 6 S.
• Fussnoten: Gesehen am 14.03.2019
• Titel Quelle: Enthalten in: Annals of hematology
• Jahr Quelle: 2016
• Band/Heft Quelle: 95(2016), 4, S. 557-562
• ISSN Quelle: 1432-0584
• DOI: doi:10.1007/s00277-016-2598-x
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1590315782

Abstract

The FIP1L1-PDGFRA (FP) fusion gene is identified in a substantial proportion of patients with eosinophilia-associated myeloproliferative neoplasms (MPN-eo) who subsequently achieve rapid and durable remissions on imatinib. In the initial diagnostic work-up of hypereosinophilia (HE), histologic and immunohistochemical evaluation of a bone marrow (BM) core biopsy is considered essential for the differentiation between reactive hypereosinophilia (HER), MPN-eo and hypereosinophilic syndrome (HES). We therefore retrospectively analysed the initial reports of BM core biopsies from 116 patients who were subsequently identified as FP positive (FP+, n = 56) or FP negative/corticosteroid-responsive HER or HES (n = 60). Compared to HER or HES, detection of FP was more frequently associated with increased numbers of blasts (11/56 vs. 2/60, p = 0.007) and mast cells (23/33 vs. 7/23, p = 0.006; with expression of CD25 [11/18 vs. 2/13, p = 0.025]), and/or fibrosis (25/35 vs. 1/23, p < 0.0001). In FP+ patients, HE was correctly associated with an underlying clonal haematologic disorder in only 36/56 (64 %) of cases, but final BM diagnoses included a variety of diagnoses such as MPN-eo (n = 15), acute myeloid leukaemia (n = 8), systemic mastocytosis (n = 6), chronic myeloid leukaemia (n = 5) or unclassified MPN (n = 2). We conclude that the final evaluation of BM core biopsies in the diagnostic work-up of HE should include comprehensive morphologic (stains for myeloid blast cells, mast cells and fibres) and genetic analyses before a final diagnosis is established.