HAEM5:Chronic eosinophilic leukaemia - Revision history

Bailey.Glen at 17:12, 3 July 2025

2025-07-03T17:12:16Z

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	~~==WHO Essential and Desirable Genetic Diagnostic Criteria==~~
	<span style="color:#0070C0">(''Instructions: The table will have the diagnostic criteria from the WHO book <u>autocompleted</u>; remove any <u>non</u>-genetics related criteria. If applicable, add text about other classification'' ''systems that define this entity and specify how the genetics-related criteria differ.'')</span>
	~~{\| class="wikitable"~~
	\|+
	\|WHO Essential Criteria (Genetics)*
	\|
	\|-
	\|WHO Desirable Criteria (Genetics)*
	\|
	\|-
	~~\|Other Classification~~
	\|
	\|}
	<nowiki>*</nowiki>Note: These are only the genetic/genomic criteria. Additional diagnostic criteria can be found in the [https://tumourclassification.iarc.who.int/home <u>WHO Classification of Tumours</u>].
	==Related Terminology==		==Related Terminology==

Bailey.Glen at 21:31, 25 May 2025

2025-05-25T21:31:43Z

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	{\| class="wikitable sortable"		{\| class="wikitable sortable"
	\|-		\|-
	!Chr #!!~~'''~~Gain, Loss, Amp, LOH~~'''~~!!~~'''~~Minimal Region Cytoband and/or Genomic Coordinates [Genome Build; Size]~~'''~~!!~~'''~~Relevant Gene(s)~~'''~~		!Chr #!!Gain, Loss, Amp, LOH!!Minimal Region Cytoband and/or Genomic Coordinates [Genome Build; Size]!!Relevant Gene(s)
	!~~'''~~Diagnostic, Prognostic, and Therapeutic Significance - D, P, T~~'''~~		!Diagnostic, Prognostic, and Therapeutic Significance - D, P, T
	!~~'''~~Established Clinical Significance Per Guidelines - Yes or No (Source)~~'''~~		!Established Clinical Significance Per Guidelines - Yes or No (Source)
	!~~'''~~Clinical Relevance Details/Other Notes~~'''~~		!Clinical Relevance Details/Other Notes
	\|-		\|-
	\|<span class="blue-text">EXAMPLE:</span>		\|<span class="blue-text">EXAMPLE:</span>
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	!Chromosomal Pattern		!Chromosomal Pattern
	!Molecular Pathogenesis		!Molecular Pathogenesis
	!~~'''~~Prevalence -~~'''~~		!Prevalence -
	~~'''~~Common >20%, Recurrent 5-20% or Rare <5% (Disease)~~'''~~		Common >20%, Recurrent 5-20% or Rare <5% (Disease)
	!~~'''~~Diagnostic, Prognostic, and Therapeutic Significance - D, P, T~~'''~~		!Diagnostic, Prognostic, and Therapeutic Significance - D, P, T
	!~~'''~~Established Clinical Significance Per Guidelines - Yes or No (Source)~~'''~~		!Established Clinical Significance Per Guidelines - Yes or No (Source)
	!~~'''~~Clinical Relevance Details/Other Notes~~'''~~		!Clinical Relevance Details/Other Notes
	\|-		\|-
	\|<span class="blue-text">EXAMPLE:</span>		\|<span class="blue-text">EXAMPLE:</span>
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	{\| class="wikitable sortable"		{\| class="wikitable sortable"
	\|-		\|-
	!Gene!!~~'''~~Genetic Alteration~~'''~~!!~~'''~~Tumor Suppressor Gene, Oncogene, Other~~'''~~!!~~'''~~Prevalence -~~'''~~		!Gene!!Genetic Alteration!!Tumor Suppressor Gene, Oncogene, Other!!Prevalence -
	~~'''~~Common >20%, Recurrent 5-20% or Rare <5% (Disease)~~'''~~		Common >20%, Recurrent 5-20% or Rare <5% (Disease)
	!~~'''~~Diagnostic, Prognostic, and Therapeutic Significance - D, P, T ~~'''~~		!Diagnostic, Prognostic, and Therapeutic Significance - D, P, T
	!~~'''~~Established Clinical Significance Per Guidelines - Yes or No (Source)~~'''~~		!Established Clinical Significance Per Guidelines - Yes or No (Source)
	!~~'''~~Clinical Relevance Details/Other Notes~~'''~~		!Clinical Relevance Details/Other Notes
	\|-		\|-
	\|<span class="blue-text">EXAMPLE:</span>''EGFR''		\|<span class="blue-text">EXAMPLE:</span>''EGFR''

Bailey.Glen at 20:08, 25 May 2025

2025-05-25T20:08:03Z

← Older revision		Revision as of 15:08, 25 May 2025
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	<nowiki>*</nowiki>Note: These are only the genetic/genomic criteria. Additional diagnostic criteria can be found in the [https://tumourclassification.iarc.who.int/home <u>WHO Classification of Tumours</u>].		<nowiki>*</nowiki>Note: These are only the genetic/genomic criteria. Additional diagnostic criteria can be found in the [https://tumourclassification.iarc.who.int/home <u>WHO Classification of Tumours</u>].
	==Related Terminology==		==Related Terminology==
	~~<span style="color:#0070C0">(''Instructions: The table will have the related terminology from the WHO <u>autocompleted</u>.)''</span>~~
	{\| class="wikitable"		{\| class="wikitable"
	\|+		\|+
	\|Acceptable		\|Acceptable
	\|		\|Chronic eosinophilic leukaemia NOS
	\|-		\|-
	\|Not Recommended		\|Not Recommended
	\|		\|N/A
	\|}		\|}

Bailey.Glen at 17:34, 24 March 2025

2025-03-24T17:34:39Z

← Older revision		Revision as of 12:34, 24 March 2025
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	{{DISPLAYTITLE:Chronic eosinophilic leukaemia}}		{{DISPLAYTITLE:Chronic eosinophilic leukaemia}}

	[[HAEM5:Table_of_Contents\|Haematolymphoid Tumours (WHO Classification, 5th ed.)]]		[[HAEM5:Table_of_Contents\|Haematolymphoid Tumours (WHO Classification, 5th ed.)]]

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	Pending Review*		Pending Review*

	~~__TOC__~~

	==WHO Classification of Disease==		==WHO Classification of Disease==

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2025-02-11T12:58:46Z

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Bailey.Glen at 18:43, 10 February 2025

2025-02-10T18:43:13Z

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Bailey.Glen at 18:15, 10 February 2025

2025-02-10T18:15:10Z

← Older revision		Revision as of 13:15, 10 February 2025
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	<blockquote class='blockedit'>{{Box-round\|title=v4:Clinical Features\|The content below was from the old template. Please incorporate above.}}		<blockquote class='blockedit'>{{Box-round\|title=v4:Clinical Features\|The content below was from the old template. Please incorporate above.}}</blockquote>

	CEL, NOS is sometimes discovered incidentally in otherwise asymptomatic individuals. In other instances, patients experience constitutional symptoms including weight loss, night sweats, fever, fatigue, cough, angioedema, muscle pain, pruritis and diarrhea. Endomyocardial fibrosis with ensuing restrictive cardiomegaly is known to precipitate the most severe clinical presentation. Scarring of the bicuspid and mitral valves can lead to valvular regurgitation and intracardiac thrombi formation which may embolize to the brain and other organs. Cardiac failure may also occur. Peripheral neuropathy, central nervous system dysfunction and pulmonary symptoms due to lung infiltration as well as rheumatological findings are also common. [1]		CEL, NOS is sometimes discovered incidentally in otherwise asymptomatic individuals. In other instances, patients experience constitutional symptoms including weight loss, night sweats, fever, fatigue, cough, angioedema, muscle pain, pruritis and diarrhea. Endomyocardial fibrosis with ensuing restrictive cardiomegaly is known to precipitate the most severe clinical presentation. Scarring of the bicuspid and mitral valves can lead to valvular regurgitation and intracardiac thrombi formation which may embolize to the brain and other organs. Cardiac failure may also occur. Peripheral neuropathy, central nervous system dysfunction and pulmonary symptoms due to lung infiltration as well as rheumatological findings are also common. [1]

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	==Sites of Involvement==		==Sites of Involvement==
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	<blockquote class='blockedit'>{{Box-round\|title=v4:Chromosomal Rearrangements (Gene Fusions)\|The content below was from the old template. Please incorporate above.}}		<blockquote class='blockedit'>{{Box-round\|title=v4:Chromosomal Rearrangements (Gene Fusions)\|The content below was from the old template. Please incorporate above.}}</blockquote>

	No single or specific genetic abnormality has been identified in CEL, NOS. Rearrangement of PDGFRA, PDGFRB, or FGFR1 excludes the diagnosis of CEL, NOS. PCM1-JAK2, ETV6-JAK2, or BCR-JAK2 are also specifically excluded. [1] Three unique cases of myeloid/lymphoid neoplasm with eosinophilia have shown ''FLT3'' rearrangement: one with t(13;14)(q12;q32)/''TRIP11-FLT3'' rearrangement, and two with ''ETV6-FLT3''. Eosinophilia and ''FLT3'' rearrangement typically shows myeloproliferative neoplasms, most frequently CEL, NOS, and T-ALL. [5] A unique case of CEL,NOS with a novel fusion gene between exon 22 of GCC2 and exon 12 of PDGFRB was detected and confirmed by PCR in a 54 year old man presenting with cough and dyspnea. [6]		No single or specific genetic abnormality has been identified in CEL, NOS. Rearrangement of PDGFRA, PDGFRB, or FGFR1 excludes the diagnosis of CEL, NOS. PCM1-JAK2, ETV6-JAK2, or BCR-JAK2 are also specifically excluded. [1] Three unique cases of myeloid/lymphoid neoplasm with eosinophilia have shown ''FLT3'' rearrangement: one with t(13;14)(q12;q32)/''TRIP11-FLT3'' rearrangement, and two with ''ETV6-FLT3''. Eosinophilia and ''FLT3'' rearrangement typically shows myeloproliferative neoplasms, most frequently CEL, NOS, and T-ALL. [5] A unique case of CEL,NOS with a novel fusion gene between exon 22 of GCC2 and exon 12 of PDGFRB was detected and confirmed by PCR in a 54 year old man presenting with cough and dyspnea. [6]
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	* Individual Region Genomic Gain/Loss/LOH		* Individual Region Genomic Gain/Loss/LOH
	* Characteristic Chromosomal Patterns		* Characteristic Chromosomal Patterns
	* Gene Mutations (SNV/INDEL)}}		* Gene Mutations (SNV/INDEL)}}</blockquote>

	Although survival is variable, acute transformation is common and prognosis is typically poor. The median survival time in one small series was 22.2 months. Response to imatinib has been reported but is uncommon. Treatment with Interferon alpha leading to cytogenic remission has been reported in 3 cases with translocations with a 5q31-33 breakpoint. Complete hematologic response has been achieved in one reported case of CEL with ETV6/FLT3 fusion, with the off-label use of FLT3-inhibitor, sorafenib.[2] Unfavorable prognostic findings include marked splenomegaly, blasts in the blood or increased blasts in bone marrow, cytogenetic abnormalities, and dysplastic features in other myeloid lineages. [1] According to a study of 17 cases defined by WHO-2016 standards, univariate survival analysis showed predictors of inferior survival included megakaryocytic atypia (''P'' = .01), peripheral blood eosinophilic atypia (''P'' = .024), LDH (''P'' = .046) and abnormal karyotype (''P'' = .020). [4] Of these patients, the most frequently utilized first line agents were hydroxyurea as a single agent or in combination with steroids, steroids as a single agent, or in combination. Half of patients treated with hydroxyurea based regimens responded with a persistent decline in eosinophil count over 17.5 months. Approximately one third of patients demonstrated response to steroids for a median duration of 13 months. Three of these patients were treated with imatinib of which two had normalization of eosinophil count. [4] Imatinib was successful in treatment of the individual case of CEL,NOS with novel fusion gene involving PDGFRB and GCC2 with disappearance of the fusion gene in bone marrow after three months. [6]		Although survival is variable, acute transformation is common and prognosis is typically poor. The median survival time in one small series was 22.2 months. Response to imatinib has been reported but is uncommon. Treatment with Interferon alpha leading to cytogenic remission has been reported in 3 cases with translocations with a 5q31-33 breakpoint. Complete hematologic response has been achieved in one reported case of CEL with ETV6/FLT3 fusion, with the off-label use of FLT3-inhibitor, sorafenib.[2] Unfavorable prognostic findings include marked splenomegaly, blasts in the blood or increased blasts in bone marrow, cytogenetic abnormalities, and dysplastic features in other myeloid lineages. [1] According to a study of 17 cases defined by WHO-2016 standards, univariate survival analysis showed predictors of inferior survival included megakaryocytic atypia (''P'' = .01), peripheral blood eosinophilic atypia (''P'' = .024), LDH (''P'' = .046) and abnormal karyotype (''P'' = .020). [4] Of these patients, the most frequently utilized first line agents were hydroxyurea as a single agent or in combination with steroids, steroids as a single agent, or in combination. Half of patients treated with hydroxyurea based regimens responded with a persistent decline in eosinophil count over 17.5 months. Approximately one third of patients demonstrated response to steroids for a median duration of 13 months. Three of these patients were treated with imatinib of which two had normalization of eosinophil count. [4] Imatinib was successful in treatment of the individual case of CEL,NOS with novel fusion gene involving PDGFRB and GCC2 with disappearance of the fusion gene in bone marrow after three months. [6]

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	==Individual Region Genomic Gain / Loss / LOH==		==Individual Region Genomic Gain / Loss / LOH==
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	==Characteristic Chromosomal Patterns==		==Characteristic Chromosomal Patterns==
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	<blockquote class='blockedit'>{{Box-round\|title=v4:Characteristic Chromosomal Aberrations / Patterns\|The content below was from the old template. Please incorporate above.}}		<blockquote class='blockedit'>{{Box-round\|title=v4:Characteristic Chromosomal Aberrations / Patterns\|The content below was from the old template. Please incorporate above.}}</blockquote>

	A recurrent karyotypic abnormality typically observed in myeloid disorders such as gain of chromosome 8, loss of chromosome 7 or isochromosome 17q supports a diagnosis as well as the presence of a translocation. [1] [1] Morsia et al demonstrated cytogenetic abnormalities in 15 of 17 (88.2%) patients diagnosed with CEL, NOS including trisomy 8 (n = 4), and complex karyotype (n = 3). [4]		A recurrent karyotypic abnormality typically observed in myeloid disorders such as gain of chromosome 8, loss of chromosome 7 or isochromosome 17q supports a diagnosis as well as the presence of a translocation. [1] [1] Morsia et al demonstrated cytogenetic abnormalities in 15 of 17 (88.2%) patients diagnosed with CEL, NOS including trisomy 8 (n = 4), and complex karyotype (n = 3). [4]

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	==Gene Mutations (SNV / INDEL)==		==Gene Mutations (SNV / INDEL)==
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	<blockquote class='blockedit'>{{Box-round\|title=v4:Gene Mutations (SNV/INDEL)\|The content below was from the old template. Please incorporate above.}}		<blockquote class='blockedit'>{{Box-round\|title=v4:Gene Mutations (SNV/INDEL)\|The content below was from the old template. Please incorporate above.}}</blockquote>

	JAK2 mutations have been identified, however mutations in ASXL1, TET2 and EZH2 appear to be common. [1] The study by Morsia et al. of 17 CEL patients demonstrated two patients each with 13q, 20q deletion, and chromosome 1 abnormalities, one patient with monosomy 7 and one with 3q deletion. All seven patients with NGS studies harbored one or more mutations; ''ASXL1'' (42.9%); ''IDH1'' (28.6%), and one each (14.3%) with ''TP53'', ''SRSF2'', ''SH2B3'', ''STAT5B'', ''KDM6A'' and ''NF1'' mutations. [4] A novel ''JAK2'' exon 13 insertion/deletion mutant has been identified and described by Patel et al. in a patient fulfilling diagnostic criteria for both PV and CEL. This study demonstrated that JAK2ex13InDel bears mechanistic resemblance to JAK2V617F but can activate STAT5 in the absence of βc family cytokines IL-3, IL-5, and GM-CSF, potentially promoting eosinophilic differentiation. [7] Keleman et al. discussed STAT5B mutations as reported in four cases: two cases of CEL, NOS; one case of CMML with eosinophilia; and one case of MDS with eosinophilia, respectively. While the presence of a STAT5B N642H mutation may be a potential marker of chronic eosinophilic neoplasms, similar mutations have been described in nonclonal HE and may not be independently sufficient to establish a diagnosis of CEL, NOS. [8]		JAK2 mutations have been identified, however mutations in ASXL1, TET2 and EZH2 appear to be common. [1] The study by Morsia et al. of 17 CEL patients demonstrated two patients each with 13q, 20q deletion, and chromosome 1 abnormalities, one patient with monosomy 7 and one with 3q deletion. All seven patients with NGS studies harbored one or more mutations; ''ASXL1'' (42.9%); ''IDH1'' (28.6%), and one each (14.3%) with ''TP53'', ''SRSF2'', ''SH2B3'', ''STAT5B'', ''KDM6A'' and ''NF1'' mutations. [4] A novel ''JAK2'' exon 13 insertion/deletion mutant has been identified and described by Patel et al. in a patient fulfilling diagnostic criteria for both PV and CEL. This study demonstrated that JAK2ex13InDel bears mechanistic resemblance to JAK2V617F but can activate STAT5 in the absence of βc family cytokines IL-3, IL-5, and GM-CSF, potentially promoting eosinophilic differentiation. [7] Keleman et al. discussed STAT5B mutations as reported in four cases: two cases of CEL, NOS; one case of CMML with eosinophilia; and one case of MDS with eosinophilia, respectively. While the presence of a STAT5B N642H mutation may be a potential marker of chronic eosinophilic neoplasms, similar mutations have been described in nonclonal HE and may not be independently sufficient to establish a diagnosis of CEL, NOS. [8]
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	==Epigenomic Alterations==		==Epigenomic Alterations==
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	==Genetic Diagnostic Testing Methods==		==Genetic Diagnostic Testing Methods==

Bailey.Glen at 22:15, 6 September 2024

2024-09-06T22:15:26Z

← Older revision		Revision as of 17:15, 6 September 2024
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	__TOC__		__TOC__

	==~~Cancer Category / Type~~==		==WHO Classification of Disease==

	Myeloproliferative ~~Neoplasm~~		{\| class="wikitable"
			!Structure
	~~==Cancer Sub~~-~~Classification /~~ Subtype==		!Disease
			\|-
			\|Book
			\|Haematolymphoid Tumours (5th ed.)
			\|-
			\|Category
			\|Myeloid proliferations and neoplasms
			\|-
			\|Family
			\|Myeloproliferative neoplasms
			\|-
			\|Type
			\|Myeloproliferative neoplasms
			\|-
			\|Subtype(s)
			\|Chronic eosinophilic leukaemia
			\|}

	==Definition / Description of Disease==		==Definition / Description of Disease==

Bailey.Glen at 21:53, 6 September 2024

2024-09-06T21:53:48Z

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Bailey.Glen: Undo revision 14840 by Bailey.Glen (talk)

2024-09-04T00:26:57Z

Undo revision 14840 by Bailey.Glen (talk)

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