Department of Hematology, Roskilde University Hospital, Denmark; The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark.
Am J Hematol. 2013 Oct;88(10):843-7. doi: 10.1002/ajh.23515. Epub 2013 Aug 1.
Eosinophilia may represent an early paraclinical sign of hematological malignant disease, but no reports exist on its predictive value for hematological malignancies. From the Copenhagen Primary Care Differential Count (CopDiff) Database, we identified 356,196 individuals with at least one differential cell count (DIFF) encompassing the eosinophil count during 2000-2007. From these, one DIFF was randomly chosen and categorized according to no (<0.5 × 10(9) /L), mild (≥ 0.5-1.0 × 10(9) /L) or severe (≥ 1.0 × 10(9) /L) eosinophilia. From the Danish Cancer Registry and the Danish Civil Registration System, we ascertained hematological malignancies and death within 3 years following the DIFF. Using multivariable logistic regression odds ratios (ORs) were calculated and adjusted for previous eosinophilia in a DIFF, sex, age, year, month, C-reactive protein, previous cancer, and comorbidity. ORs for developing Hodgkin's lymphoma (HL) was significantly increased in individuals exhibiting severe eosinophilia, OR = 9.09 (C.I. 2.77-29.84), P = 0.0003. The association with classical myeloproliferative neoplasms (cMPNs) showed an increasing risk with OR = 1.65 (1.04-2.61) P = 0.0322 and OR = 3.87 (1.67-8.96) P = 0.0016 for mild and severe eosinophilia. Eosinophilia was in a similar fashion associated with chronic lymphatic leukemia (CLL), OR = 2.57 (1.50-4.43), P = 0.0006 and OR = 5.00 (1.57-15.94), P = 0.0065, and all-cause death, OR of 1.16 (1.09-1.24), P < 0.0001 and 1.60 (1.35-1.91), P < 0.0001. We confirm associations between eosinophilia and HL and cMPNs, and in addition for the first time demonstrate a dose-dependent association between eosinophilia and CLL as well as death. Unexplained eosinophilia should prompt clinicians to consider conditions where early diagnosis may improve prognosis.
嗜酸性粒细胞增多可能是血液恶性肿瘤的早期临床前迹象，但目前尚无关于其对血液恶性肿瘤预测价值的报道。我们从哥本哈根初级保健差异计数（CopDiff）数据库中确定了 356196 名至少有一次差异细胞计数（DIFF）包含嗜酸性粒细胞计数的个体，这些计数是在 2000-2007 年期间进行的。从这些人中，随机选择一次 DIFF，并根据嗜酸性粒细胞计数<0.5×10（9）/L、轻度（≥0.5-1.0×10（9）/L）或重度（≥1.0×10（9）/L）进行分类。从丹麦癌症登记处和丹麦民事登记系统中，我们确定了 DIFF 后 3 年内发生的血液恶性肿瘤和死亡。使用多变量逻辑回归比值比（OR）进行计算，并根据之前 DIFF 中的嗜酸性粒细胞增多、性别、年龄、年份、月份、C 反应蛋白、之前的癌症和合并症进行调整。严重嗜酸性粒细胞增多患者患霍奇金淋巴瘤（HL）的 OR 显著增加，OR=9.09（CI 2.77-29.84），P=0.0003。与经典骨髓增生性肿瘤（cMPNs）的关联显示，轻度和重度嗜酸性粒细胞增多的风险呈上升趋势，OR=1.65（1.04-2.61），P=0.0322，OR=3.87（1.67-8.96），P=0.0016。嗜酸性粒细胞增多也以类似的方式与慢性淋巴细胞白血病（CLL）相关，OR=2.57（1.50-4.43），P=0.0006，OR=5.00（1.57-15.94），P=0.0065，全因死亡，OR 为 1.16（1.09-1.24），P<0.0001，OR 为 1.60（1.35-1.91），P<0.0001。我们证实了嗜酸性粒细胞增多与 HL 和 cMPNs 之间的关联，此外，我们首次证明嗜酸性粒细胞增多与 CLL 以及死亡之间存在剂量依赖性关联。不明原因的嗜酸性粒细胞增多应促使临床医生考虑可能通过早期诊断改善预后的情况。
