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What is Leukemia - Eosinophilic?
Leukemia is a cancer of the blood cells. Leukemia begins when normal blood cells change and grow uncontrollably. Blood cells are produced in the bone marrow, the spongy tissue inside the larger bones in the body. There are different types of blood cells, including red blood cells that carry oxygen throughout the body, white cells that fight infection, and platelets that help the blood to clot. Abnormalities (changes) in the bone marrow cells can cause too many or too few of certain blood cells. There are four main types of leukemia in adults:
Acute lymphocytic leukemia (ALL)
Chronic lymphocytic leukemia (CLL)
Acute myeloid leukemia (AML)
Chronic myeloid leukemia (CML)
About eosinophilic leukemia
Eosinophilia is a condition that develops when the bone marrow makes too many eosinophils, a type of white blood cell. People can have many eosinophils without having leukemia. For example, sometimes the body makes too many eosinophils because of an allergy or an infection with a parasite. This type of eosinophilia is called secondary eosinophilia and is much more common than eosinophilic leukemia.
Chronic eosinophilic leukemia is a subtype of clonal eosinophilia, meaning it is caused by a new genetic mutation (change) in the blood cells. It is sometimes called hypereosinophilic syndrome (HES). This disease is classified as a myeloproliferative disorder (myelo- means bone marrow and proliferative means too much).
This section focuses on chronic eosinophilic leukemia. Acute eosinophilic leukemia is rare and is treated similarly to acute myeloid leukemia (AML).
Symptoms and Signs
People with eosinophilic leukemia may experience the following symptoms or signs. Sometimes, people with eosinophilic leukemia do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom or sign on this list, please talk with your doctor.
Fever
Unexplained fatigue or shortness of breath
Cough
Swollen lymph nodes
Muscle pains
Itching
Diarrhea
Your doctor will ask you questions about the symptoms you are experiencing to help find out the cause of the problem, called a diagnosis. This may include how long you've been experiencing the symptoms(s) and how often.
If eosinophilic leukemia is diagnosed, relieving symptoms and side effects remains an important part of care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.
Risk Factors
A risk factor is anything that increases a person's chance of developing cancer. Although risk factors often influence the development of leukemia, most do not directly cause leukemia. Some people with several risk factors never develop leukemia, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.
Leukemia can be caused by a genetic mutation that is inherited (passed from generation to generation within a family) or develops during a person's life because of environmental factors, smoking, and chemical or radiation exposure. However, no specific cause can be found for most patients with leukemia.
Diagnosis
Doctors use many tests to diagnose eosinophilia. Although a patient's signs and symptoms may cause a doctor to suspect eosinophilic leukemia, it is diagnosed only by testing a patient's blood and bone marrow. Some tests may also help doctors decide which treatments may be the most effective. Your doctor may consider these factors when choosing a diagnostic test:
Age and medical condition
Type of leukemia suspected
Severity of symptoms
Previous test results
The main criteria for diagnosing eosinophilic leukemia are:
An eosinophil count in the blood of 1.5 x 109 /L or higher that lasts over time
No parasitic infection, allergic reaction, or other causes of eosinophilia
Problems with the functioning of a person's organs because of the eosinophilia
In addition to a physical examination, the following tests may be used to diagnose eosinophilic leukemia:
Blood tests. The diagnosis of eosinophilic leukemia begins with a test called a complete blood count (CBC), which measures the number of different types of cells in a person's blood. If the blood contains many eosinophils (see criteria above), eosinophilic leukemia is suspected.
Bone marrow biopsy and aspiration. These two procedures are similar and often done at the same time. Bone marrow has both a solid and liquid part. A bone marrow biopsy is the removal of a small amount of solid tissue using a needle. An aspiration removes a sample of fluid with a needle. The sample(s) are then analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease) to determine the number and type of abnormal cells. A common site for a bone marrow biopsy and aspiration is the pelvic bone, which is located in the lower back by the hip. The skin in that area is usually numbed with medication beforehand, and other types of anesthesia (medication to block awareness of pain) may be used.
Many immature cells, called blasts, are a sign of acute rather than chronic eosinophilic leukemia. Acute eosinophilic leukemia is not covered in this article and is treated similarly to AML.
Molecular testing. Your doctor may recommend running laboratory tests on the leukemia cells to identify specific genes, proteins, and other factors unique to the leukemia. If many eosinophils are found, a molecular genetic analysis should be done to test for a mutation that makes an abnormal protein known as FIP1-like-1/platelet-derived growth factor alpha. Immunophenotyping is the examination of the proteins on the surface of the leukemia cells and helps the doctor to confirm the exact type of leukemia. Cytogenetics is the examination of the leukemia cells for chromosome (long strand of genes) abnormalities. It also helps the doctor confirm the diagnosis and may help to determine the person's prognosis (chance of recovery). Results of these tests will also help decide whether your treatment options include a type of treatment called targeted therapy.
Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient's vein to provide better detail. A CT scan also shows enlarged lymph nodes or a swollen spleen or liver.
Evaluation of the heart. People who have many eosinophils for a long period of time often have problems with heart function and rhythm. The doctor may recommend an electrocardiogram (ECG or EKG, a noninvasive test that looks for abnormal heart rhythms or heart damage) and/or an echocardiogram (ECHO, a noninvasive test that looks at the structure and function of the heart using sound waves and an electronic sensor).
Stages
Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis. There are different stage descriptions for different types of cancer.
Unlike most solid tumors, leukemias do not have a formal staging system. Regular blood tests are the main ways to monitor a person's recovery from eosinophilic leukemia, including any symptoms related to the disease and the number of immature cells in the bone marrow.
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