2022年医学专题—HES及克隆性嗜酸性粒细胞增多症.ppt

高嗜酸性粒细胞综合症及嗜酸性粒细胞增多症：诊断要点(yodin)和治疗进展,第一页，共二十三页。,Tefferi A,Gotlib J,Pardanani A.Hypereosinophilic syndrome and clonal eosinophilia:point-of-care diagnostic algorithm and treatment update.Mayo Clin Proc.2010;85(2):158-64.,第二页，共二十三页。,Acquired eosinophilia,Acquired eosinophilia is operationally categorized into secondary,clonal,and idiopathic types.Causes of secondary eosinophilia include parasite infections,allergic or vasculitis conditions,drugs,and lymphoma.Clonal eosinophilia is distinguished from idiopathic eosinophilia by the presence of histologic,cytogenetic,or molecular evidence of an underlying myeloid malignancy.,第三页，共二十三页。,获得性嗜酸性(sun xn)粒细胞增多症,获得性嗜酸性粒细胞增多症被人为的分为继发性,克隆性和特发性三种类型。继发性嗜酸性粒细胞增多的原因包括：寄生虫感染、过敏或血管炎,药物和淋巴瘤。克隆性嗜酸性粒细胞增多是区别于特发性嗜酸性粒细胞增多的，通过(tnggu)组织学、细胞遗传学、或潜在的髓系恶性增生的分子证据。,第四页，共二十三页。,Clonaleosinophilia,The World Health Organization classification system for hematologic malignancies recognizes 2 distinct subcategories ofclonaleosinophilia:chronic eosinophilic leukemia,not otherwise specified(CEL-NOC)and myeloid/lymphoid neoplasms with eosinophilia and mutations involving platelet-derived growth factor receptor alpha/beta(PDGFRA or PDGFRB)or fibroblast growth factor receptor 1(FGFR1).,第五页，共二十三页。,克隆(k ln)性嗜酸性粒细胞增多症,世界卫生组织恶性血液病分类系统将克隆性嗜酸性粒细胞增多症分为2个不同(b tn)的亚型：未另行规定的慢性嗜酸性白血病和伴有血小板源生长因子受体/或纤维母细胞生长因子受体1基因突变的髓系/淋巴系肿瘤。,第六页，共二十三页。,Clonaleosinophilia,Clonal eosinophilia might also accompany other World Health Organization-defined myeloid malignancies,including chronic myelogenous leukemia,myelodysplastic syndromes,chronic myelomonocytic leukemia,and systemic mastocytosis.,第七页，共二十三页。,克隆(k ln)性嗜酸性粒细胞增多症,克隆性嗜酸性粒细胞增多症也可能(knng)伴发其他世界卫生组织定义的髓系恶性肿瘤,包括慢性粒细胞性白血病、骨髓增生异常综合征,慢性髓单核细胞白血病、系统性肥大细胞增多症。,第八页，共二十三页。,Hypereosinophilicsyndrome(HES),Hypereosinophilicsyndrome(HES),a subcategory of idiopathic eosinophilia,is defined by the presence of a peripheral blood eosinophil count of 1.5 x 10(9)/L or greater for at least 6 months(a shorter duration is acceptable in the presence of symptoms that require eosinophil-lowering therapy),exclusion of both secondary andclonaleosinophilia,evidence of organ involvement,and absence of phenotypically abnormal and/orclonalT lymphocytes.,第九页，共二十三页。,高嗜酸性(sun xn)粒细胞综合征,高嗜酸性粒细胞综合征，即特发性嗜酸性粒细胞增多症的一个亚类,被定义为存在外周血嗜酸性粒细胞计数1.5 x 10(9)/L或更高至少(zhsho)6个月(当出现需要给予降低嗜酸性粒细胞治疗的症状时，更短时间内是可以接受的)，同时需要排除继发性和克隆性嗜酸性粒细胞增多，克隆性嗜酸性粒细胞增多的证据包括器官受累,没有表型上的异常和/或克隆T淋巴细胞增多症。,第十页，共二十三页。,Lymphocytic variant hyper eosinophilia,The presence of the latter defines lymphocytic variant hyper eosinophilia,which is best classified under secondary eosinophilia.In the current review,we provide a simplified algorithm for distinguishing the various causes ofclonaland idiopathic eosinophilia and discuss current therapy,including new drugs(imatinib mesylate,alemtuzumab,and mepolizumab).,第十一页，共二十三页。,淋巴细胞变异型高嗜酸性(sun xn)粒细胞增多症,后者的存在定义为淋巴细胞变异型高嗜酸性粒细胞增多症,最好(zu ho)将其归类为继发性嗜酸性粒细胞增多症。在当前的这篇评论性文章中,我们提供了一个简化的算法区别各种原因引起的克隆性和特发性嗜酸性粒细胞增多并讨论当前的治疗方法,包括新药(甲磺酸伊马替尼,CD52单抗-阿仑单抗和IL-5单抗-美泊利单抗)。,第十二页，共二十三页。,第十三页，共二十三页。,FIGURE.Diagnostic algorithm for clonal or idiopathic eosinophilia.CEL-NOS=chronic eosinophilic leukemia,not otherwise specified;FISH=fluorescence in situ hybridization;HES=hypereosinophilic syndrome;PDGFR=platelet-derived growth factor receptor;RT-PCR=reverse transcription polymerase chain reaction;TCR=T-cell receptor;WHO=World Health Organization.,第十四页，共二十三页。,Tefferi A.Blood eosinophilia:a new paradigm in disease classification,diagnosis,and treatment.Mayo Clin Proc.2005;80(1):75-83.,第十五页，共二十三页。,Tefferi A.Modern diagnosis andtreatmentof primary eosinophilia.Acta Haematol.2005;114(1):52-60.,第十六页，共二十三页。,Tefferi A,Patnaik MM,Pardanani A.Eosinophilia:secondary,clonal and idiopathic.Br J Haematol.2006;133(5):468-92.,第十七页，共二十三页。,Pardanani A,Tefferi A.Primary eosinophilic disorders:a concise review.Curr Hematol Malig Rep.2008;3(1):37-43.,第十八页，共二十三页。,Tefferi A,Vardiman JW.Classification and diagnosis of myeloproliferative neoplasms:the 2008 World Health Organization criteria and point-of-care diagnostic algorithms.Leukemia.2008;22(1):14-22.,第十九页，共二十三页。,Tefferi A,Gotlib J,Pardanani A.Hypereosinophilic syndrome and clonal eosinophilia:point-of-care diagnostic algorithm and treatment update.Mayo Clin Proc.2010;85(2):158-64.,第二十页，共二十三页。,Corresponding author,Ayalew Tefferi,MD Divisions of Hematology and Internal Medicine,Mayo Clinic,200 First Street SW,Rochester,Minn.,USA,第二十一页，共二十三页。,Thank you!,第二十二页，共二十三页。,内容(nirng)总结,高嗜酸性粒细胞综合症及嗜酸性粒细胞增多(zn du)症：诊断要点和治疗进展。Thank you,第二十三页，共二十三页。,