Hypereosinophilia during 2-chlorodeoxyadenosine treatment for hairy cell leukaemia.
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 of the eosinophil population showed a high expression of the IL-2 receptor alpha-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.
Rutella
S
S
Department of Haematology, Catholic University, Rome, Italy.
Sica
S
S
Rumi
C
C
Martucci
R
R
Etuk
B
B
De Stefano
V
V
Testa
U
U
Leone
G
G
Peschle
C
C
D000328:Adult; D017338:Cladribine / Q000009:adverse effects*; D004804:Eosinophils; D005434:Flow Cytometry; D006801:Humans; D017681:Hypereosinophilic Syndrome / Q000139:chemically induced* / Q000276:immunology; D015848:Interleukin-5 / Q000097:blood; D007943:Leukemia, Hairy Cell / Q000188:drug therapy* / Q000276:immunology; D008297:Male; D015375:Receptors, Interleukin-2 / Q000378:metabolism
D015848:Interleukin-5; D015375:Receptors, Interleukin-2; D017338:Cladribine