Hypereosinophilia during 2-chlorodeoxyadenosine treatment for hairy cell leukaemia |
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Authors: | Sergio,Rutella ,Simona,Sica ,Carlo,Rumi ,Robert,Martucci ,Benedict,Etuk ,Valerio,De Stefano ,Ugo,Testa ,Giuseppe,Leone & Cesare,Peschle |
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Affiliation: | Department of Haematology, Catholic University,; Department of Haematology and Oncology, Istituto Superiore di Sanità, Rome, Italy, and; Department of Microbiology and Immunology, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A. |
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Abstract: | A 43-year-old male with newly diagnosed hairy cell leukaemia underwent a single course of 2-chlorodeoxyadenosine (2-CdA). Skin rash, facial swelling and marked eosinophilia developed 20 d after treatment and were resolved by 7 d of steroid therapy. Eosinophil peak in peripheral blood reached 1230 cells/μl. Flow cytometric analysis of the eosinophil population showed a high expression of the IL-2 receptor α-chain (CD25), representing up to 94% of gated cells. HLA-DR and CD4 antigens were constantly negative; eosinophils strongly reacted with the secretory form of the eosinophil cationic protein (ECP), recognized by EG2 monoclonal antibody. IL-5 serum levels were markedly elevated at the onset of eosinophilia, returned to normal levels after its disappearance and positively correlated with eosinophil count ( r = 0.94, P = 0.016). Eosinophilia is an uncommon finding after treatment with 2-CdA. It is unclear whether these phenomena represented a true allergic reaction to the drug or the effect of massive tumour cell lysis and haemopoietic pancytopenia with immunosuppression, which induced the release of IL-5 and possibly other cytokines. |
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Keywords: | flow cytometry hairy cell leukaemia eosinophilia 2-chlorodeoxyadenosine |
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