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Features of hypereosinophilic syndrome (HES) variants

Features of hypereosinophilic syndrome (HES) variants
Terminology for HES variants Subtypes/identified abnormalities/examples Clinical and laboratory features 
Myeloid variants

PDGFRB and FGFR1 rearrangements

JAK2 point mutation and translocation

Chronic eosinophilic leukemia, not otherwise specified, on the basis of blast count in peripheral blood and/or bone marrow or of a clonal cytogenetic abnormality
↑ Serum B12

Anemia and/or thrombocytopenia

Hepatomegaly and/or splenomegaly

Circulating leukocyte precursors
Deletion on 4q12 → FIP1L1-PDGFRA fusion May show ↑ serum tryptase + mast cell abnormalities
  PDGFRA or PDGFRB rearrangement-associated disease occurs almost exclusively in males
T cell lymphocytic variants (L-HES)

Aberrant IL-5-producing T cells

Example: CD3-CD4+ T cell-associated disease

Prominent skin findings (including plaques, erythroderma, urticaria)

Polyclonal hypergammaglobulinemia

Usually a benign lymphoproliferative disorder, but may progress to T cell lymphoma
Familial HES Mapped to 5q 31-33

Asymptomatic eosinophilia from birth, autosomal dominant

Progression to other forms of HES may occur

Idiopathic HES   Multisystem involvement with varied signs/symptoms
Organ-restricted HES Examples include eosinophilic gastrointestinal disease, chronic eosinophilic pneumonia, and others Peripheral blood eosinophilia associated with eosinophilic infiltration and associated signs/symptoms in a single organ
Specific/defined syndromes associated with hypereosinophilia Examples include episodic angioedema with eosinophilia, eosinophilic granulomatosis with polyangiitis (EGPA, formerly Churg-Strauss), other disorders associated with immune dysregulation Marked eosinophilia in the setting of an underlying disorder associated with eosinophilia; the precise role of eosinophils in the disease manifestations remains uncertain
HES: hypereosinophilic syndromes; PDGFRB: platelet-derived growth factor receptor beta; FGFR1: fibroblast growth factor receptor 1; JAK2: Janus kinase 2; FIP1L1: Fip1-like1; PDGFRA: platelet-derived growth factor receptor alpha; L-HES: lymphocytic variant HES; IL-5: interleukin-5.
Graphic 59869 Version 13.0

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