Leukemia is a cancer of the blood cells. Blood cells (including red cells that carry oxygen, white cells to fight infection, and platelets that cause blood to clot) are produced in the bone marrow, the spongy tissue inside the larger bones in the body. Abnormalities in the bone marrow cells can cause the overproduction or underproduction of certain blood cells. Eosinophilia is a condition where the bone marrow makes too many eosinophils, a type of blood cell that is involved in allergic reactions or used to fight certain parasites.
Primary eosinophilia is an increased number of eosinophils. It can be clonal eosinophilia (from an acquired genetic abnormality) or idiopathic hypereosinophilia (from an unknown cause). Chronic eosinophilic leukemia is a subtype of clonal eosinophilia that is sometimes called hypereosinophilic syndrome (HES).
Some people can also have high numbers of eosinophils without having cancer. For example, sometimes the body makes too many eosinophils in response to an allergen or a parasite. This type of eosinophilia is called secondary eosinophilia. Secondary eosinophilia, the reaction to a disease or parasite, is more common than eosinophilic leukemia.
This section focuses on chronic eosinophilic leukemia. Acute eosinophilic leukemia is rare and is treated similarly to acute myeloid leukemia (AML). Read the Cancer.Net Guide: Acute Myeloid Leukemia for more information.
Statistics
Eosinophilic leukemia is rare; no specific statistics are available.
A risk factor is anything that increases a person’s chance of developing cancer. Some risk factors can be controlled, such as smoking, and some cannot be controlled, such as age and family history. Although risk factors can influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and communicating them to your doctor may help you make more informed lifestyle and health-care choices.
Leukemia can be caused by a genetic mutation brought on by heredity or environmental factors (including smoking, chemical, or radiation exposure). However, many cases of leukemia have unknown causes. The specific cause of eosinophilic leukemia is not known.
People with eosinophilic leukemia may experience the following symptoms. 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 on this list, please talk with your doctor.
Doctors use many tests, such as blood tests and bone marrow tests, to diagnose eosinophilia. Although a patient’s signs and symptoms may cause a doctor to suspect eosinophilia, it is diagnosed only by blood tests and bone marrow evaluations. Some tests may also determine which treatments may be the most effective. Your doctor may consider these factors when choosing a diagnostic test:
Age and medical condition
The type of cancer
Severity of symptoms
Previous test results
The main criteria for diagnosing eosinophilic leukemia are:
An eosinophil count in the blood greater than or equal to 1.5 x 109 /L
The absence of parasitic, allergic, or other causes of eosinophilia
Organ system involvement or dysfunction directly related to 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 routine blood test to measure the counts of different types of cells in a person's blood. If the blood contains high levels of eosinophils, eosinophilic leukemia may be present.
Bone marrow biopsy. In a bone marrow biopsy, a doctor takes a sample of marrow, usually from the back of the patient’s hipbone, with a needle. The cells from the marrow, along with the cells from the blood, are analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease) for the sample percentage of the immature cells, known as blasts. This percentage tells the doctor whether the disease is acute or chronic eosinophilic leukemia.
Immunophenotyping. Immunophenotyping is the examination of the antigens (proteins) on the surface of the leukemic cells and allows the doctor to confirm the exact type of leukemia.
Cytogenetics. Cytogenetics is the examination of the leukemic cells for chromosomal abnormalities. It assists in confirming the diagnosis and may help the doctor determine the person’s prognosis (chance of recovery).
Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the patient’s body with an x-ray machine. A computer then puts 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 vein to provide better detail. A CT scan also shows enlarged lymph nodes or a swollen spleen.
Evaluation of the heart. People with higher eosinophil counts over a longer time frequently have disturbances in heart function and rhythm. The doctor may recommend an electrocardiogram (ECG or EKG, a test that records the electrical activity of the heart to show whether there are abnormal rhythms or detect damage) and/or an echocardiogram (a procedure that evaluates the structure and function of the heart using sound waves and an electronic sensor).
Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and if 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. Chromosomal abnormalities are the main indicators used to monitor a person’s recovery from eosinophilic leukemia, as well as the disease’s response to therapy and the percentage of immature cells in the bone marrow.
The treatment of eosinophilic leukemia depends on various factors. In many cases, a team of doctors will work with the patient to determine the best treatment plan.
According to the National Cancer Institute, the best treatment for eosinophilic leukemia remains unclear. People are encouraged to enroll in clinical trials designed to evaluate new treatments. See the Clinical Trials Resources section for more information.
General treatments for myeloproliferative (myelo- refers to bone marrow, proliferative means excess) disorders, such as eosinophilic leukemia, include chemotherapy, radiation therapy, surgery, and biologic therapies. Usually, myeloproliferative disorders cannot be cured, but treatment helps to control the symptoms.
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.
Chemotherapy used in treating eosinophilic leukemia include hydroxyurea (Hydrea, Droxia), cyclophosphamide (Cytoxan, Neosar), and vincristine (Oncovin).
The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications you've been prescribed, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions through Cancer.Net Drug Information Resources, which provides links to searchable drug databases.
Radiation therapy
Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. The most common type of radiation therapy is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation therapy is given using implants, it is called internal radiation therapy or brachytherapy. Radiation therapy for eosinophilic leukemia is generally used as a palliative treatment (care given to improve quality of life by treating symptoms and side effects of the cancer or its treatment).
Side effects from radiation therapy include tiredness, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished.
Surgery
Surgery to remove the spleen (splenectomy), which also produces white blood cells, may occasionally be performed.
Biologic therapy
Biologic therapy, or immunotherapy, fights the cancer by supplying a substance (either made by the body or produced in a laboratory) to boost the body’s natural defenses. Interferon-alpha (Alferon N, Roferon-A, Intron A) is a biologic therapy that is occasionally used to treat eosinophilic leukemia.
Targeted therapy
Imatinib (Gleevec) may be useful for some patients. In many patients, the leukemic cells have a specific genetic abnormality that produces a protein that stimulates the cells to grow. Imatinib kills the abnormal eosinophils by blocking the function of this protein. Imatinib is more likely to work if this mutation is present; however, if the mutation is not present, there is still a possibility that the disease would respond to the drug. The main side effects of imatinib include the following:
Swelling around the eyes
Leg swelling
Headache
Fatigue
Rash
Musculoskeletal (joint) pain
Leg cramping
Steroids
Steroid medications are used to control some symptoms of eosinophilic leukemia and are usually prescribed for certain conditions, such as a high white blood cell count.
Stem cell transplantation
Hematopoietic stem cells are special cells that can develop into different kinds of blood cells, such as red blood cells, white blood cells, or platelets. Stem cells are found both in the circulating blood and in the bone marrow; this procedure may also be called a bone marrow translplant. In a stem cell transplantation (SCT), the person is first treated with high doses of chemotherapy and/or radiation therapy to get rid of as many cancer (leukemic) cells as possible and to prevent the immune system from reacting to and rejecting the donated stem cells. After the high-dose therapy is given, stem cells obtained from a healthy donor (usually a sibling) are infused into the patient’s bloodstream. Within two to three weeks, these cells will mature into healthy, blood-producing tissue. Until that time, people may need antibiotics to prevent and treat infection and transfusions of red blood cells and platelets.
This type of SCT is called an allogeneic SCT, or an ALLO, because the new stem cells came from a donor. Allogeneic transplantation may be a considered a good treatment option in some patients, especially those who are younger.
An autologous transplantation (AUTO) is the use of the person’s own stem cells. The blood or bone marrow stem cells are removed from the person when he or she is in complete remission and then frozen. The person then receives the same treatment given for an allogeneic transplantation, and the frozen stem cells are thawed and injected back into the bloodstream to replace the destroyed marrow. This type of transplant is rarely considered for patients with eosinophilic leukemia.
SCT is a higher-risk procedure and is not used frequently in people with eosinophilic leukemia because it is sometimes not a consistently effective therapy and because many patients with this disease are older and the risks of the procedure are higher.
Cancer and cancer treatment can cause a variety of side effects; some are easily controlled and others require specialized care. Below are some of the side effects that are more common to eosinophilic leukemia and its treatments. For more detailed information on managing these and other side effects of cancer and cancer treatment, visit the Cancer.Net Managing Side Effects section.
Constipation. Constipation is the infrequent or difficult passage of stool. About 40% of patients in palliative care (care given to improve a patient’s quality of life) experience constipation, and about 90% of patients taking opioid medications (such as morphine) experience constipation. Constipation includes fewer bowel movements, stools that are abnormally hard, discomfort, or a feeling of incomplete rectal emptying. Patients with constipation can experience pain, swelling in the abdomen, loss of appetite, nausea and/or vomiting, inability to urinate, and confusion.
Fatigue (tiredness). Fatigue is extreme exhaustion or tiredness, and is the most common problem that people with cancer experience. More than half of patients experience fatigue during chemotherapy or radiation therapy, and up to 70% of patients with advanced cancer experience fatigue. Patients who feel fatigue often say that even a small effort, such as walking across a room, can seem like too much. Fatigue can seriously affect family activities and other daily activities, can make patients avoid or skip cancer treatments, and may even affect the will to live.
Hair loss (alopecia). A potential side effect of radiation therapy and chemotherapy is hair loss. Radiation therapy and chemotherapy cause hair loss by damaging the hair follicles responsible for hair growth. Hair loss may occur throughout the body, including the head, face, arms, legs, underarms, and pubic area. The hair may fall out entirely, gradually, or in sections. In some cases, the hair will simply thin-sometimes unnoticeably-and may become duller and dryer. Losing one's hair can be a psychologically and emotionally challenging experience and can affect a patient's self-image and quality of life. However, the hair loss is usually temporary, and the hair often grows back.
Mouth sores (mucositis). Mucositis is an inflammation of the inside of the mouth and throat, leading to painful ulcers and mouth sores. It occurs in up to 40% of patients receiving chemotherapy. Mucositis can be caused by chemotherapy directly, the reduced immunity brought on by chemotherapy, or radiation therapy to the head and neck area.
Nausea and vomiting. Vomiting, also called emesis or throwing up, is the act of expelling the contents of the stomach through the mouth. It is a natural way for the body to rid itself of harmful substances. Nausea is the urge to vomit. Nausea and vomiting are preventable, treatable side effects. They are common in patients receiving chemotherapy for cancer and in some patients receiving radiation therapy. Many patients with cancer say they fear nausea and vomiting more than any other side effects of treatment, but nausea and vomiting are preventable with medication. When it is minor and treated quickly, nausea and vomiting can be quite uncomfortable but cause no serious problems. Persistent vomiting can cause dehydration, electrolyte imbalance, weight loss, depression, and avoidance of chemotherapy.
Neutropenia. Neutropenia is an abnormally low level of neutrophils, a type of white blood cell. All white blood cells help the body fight infection. Neutrophils fight infection by destroying bacteria. Patients who have neutropenia are at increased risk for developing serious bacterial infections because there are not enough neutrophils to destroy harmful bacteria. Neutropenia occurs in about 50% of patients receiving chemotherapy and is common in patients with leukemia.
Skin problems. The skin is an organ system that contains many nerves. Skin problems can be very painful, difficult to cope with, and often lead to other serious problems. As with other side effects, prevention or early treatment is best. In other cases, treatment and wound care can often improve pain and quality of life. Skin problems can have many different causes, including chemotherapy leaking out of the intravenous (IV) tube, which can cause pain or burning; peeling or burned skin caused by radiation therapy; pressure ulcers (bed sores) caused by constant pressure on one area of the body; and pruritus (itching) in patients with cancer, most often caused by leukemia, lymphoma, myeloma, or other cancers.
Thrombocytopenia. Thrombocytopenia is an unusually low level of platelets (thrombocytes) in the blood. Platelets are the blood cells that stop bleeding by plugging damaged blood vessels and helping the blood to clot. Patients with low levels of platelets bleed more easily and are prone to bruising. Certain types of chemotherapy can damage the bone marrow so that it does not make enough platelets. Thrombocytopenia caused by chemotherapy is usually temporary. Other medications used to treat cancer may also lower the number of platelets. In rare instances, a patient’s body can make antibodies to the platelets, lowering the number of platelets.
Regular communication with your doctor is important for making informed decisions about your health care. Consider asking the following questions of your doctor:
What type of leukemia do I have?
What does this mean?
How will the cancer develop? Is it possible to slow or delay this development?
Is it curable?
How can I my symptoms be controlled?
What are my treatment options?
What clinical trials are open to me?
What treatment do you recommend and why?
What type of side effects from treatment can I expect?
How can I keep myself as healthy as possible during and after treatment?
What follow-up tests will I need, and how often will I need them?
After treatment for eosinophilic leukemia ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations, blood tests, bone marrow biopsies, and possibly scans or other imaging studies to monitor your recovery for the coming months and years. People experiencing a long-term remission are encouraged to follow cancer screening recommendations for the general population.
Some cancer treatments may cause long-term side effects.
Numbness, tingling, and pain in the hands and feet may occur in people who have received vincristine.
Heart damage in the form of a weakened heart muscle may occur in people who have received a higher total dose of doxorubicin (Adriamycin) or radiation therapy to the chest.
Infertility or premature menopause can occur in people who have received high-dose cyclophosphamide or other chemotherapy.
A secondary leukemia or a secondary cancer (cancer that develops because of the treatment for another type of cancer) is more common in people who were treated with chemotherapy and radiation therapy.
Talk with your doctor or health-care team about the best ways to manage these side effects if they occur.
People recovering from eosinophilic leukemia are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about Healthy Living After Cancer.
Research for eosinophilic leukemia and other myeloproliferative disorders is ongoing. The following treatments may still be under investigation in clinical trials and may not be approved or available at this current time. Always discuss all diagnostic and treatment options with your doctor.
Because these conditions are usually associated with a genetic mutation, researchers are searching for genetic markers. New protocols for stem cell/bone marrow transplantation are being tested. Better combinations of chemotherapy and additional treatment combinations are also being explored, as is the drug mepolizumab. Mepolizumab is a humanized monoclonal antibody that binds specifically to human interleukin 5 (hIL-5) and inhibits its activity. Preliminary studies in people have shown that mepolizumab lowers blood eosinophilia in people with allergies and HES and has alleviated some clinical signs and symptoms of HES.
American Society for Blood and Marrow Transplantation
85 W. Algonquin Rd., Ste. 550
Arlington Heights, IL 60005
Phone: 847-427-0224 www.asbmt.org
Blood and Marrow Transplant Information Network
2310 Skokie Valley Rd., Ste. 104
Highland Park, IL 60035
Toll Free: 888-597-7674
Phone: 847-433-3313 www.bmtinfonet.org
Leukemia Research Foundation
3520 Lake Ave., Ste. 202
Wilmette, IL 60091
Phone: 847-424-0600
Toll Free: 888-558-5385 www.leukemia-research.org
National Bone Marrow Transplant Link
20411 W 12 Mile Rd., Ste. 108
Southfield, MI 48076
Toll Free: 800-LINK-BMT (800-546-5268)
Phone: 248-358-1886 www.nbmtlink.org
Doctors and scientists are always looking for better ways to treat patients with eosinophilic leukemia. A clinical trial is a way to test a new treatment in order to prove that it is safe, effective, and possibly better than a standard treatment. Patients who participate in clinical trials are among the first to receive new treatments, such as new chemotherapy before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.
Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that finding new drugs and other therapies is the only way to make progress in treating eosinophilic leukemia. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with eosinophilic leukemia.
To join a clinical trial, patients must complete a learning process known as informed consent. During informed consent, the doctor should list all of the patient’s options, so the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find cancer clinical trials.
Printer-Friendly
E-mail this page