Version June 2024
| Required |
| Persistent peripheral blood eosinophilia (≥1500/microL) |
| Increased numbers of bone marrow eosinophils |
| Myeloblasts <20 percent in peripheral blood or bone marrow |
| Conditions to be excluded |
| Reactive eosinophilia |
| Allergy |
| Parasitic diseases |
| Infectious diseases |
| Pulmonary disease (eg, hypersensitivity pneumonia, Loeffler's pneumonia) |
| Collagen vascular disorders |
| Neoplastic disorders with secondary reactive eosinophilia |
| T cell lymphomas (eg, mycosis fungoides, Sézary syndrome) |
| Hodgkin lymphoma |
| Acute lymphoblastic leukemia |
| Mastocytosis |
| Neoplastic disorders in which eosinophils are part of the neoplastic clone |
| Chronic myeloid leukemia (Ph1 + or BCR/ABL positive) |
| Acute myeloid leukemia [eg, FAB M4Eo with inv(16), t(16;16)(p13;q22)] |
| Other myeloproliferative disorders (eg, polycythemia vera, essential thrombocytosis, chronic idiopathic myelofibrosis) |
| T cell population with aberrant phenotype and abnormal cytokine production |
| Diagnosis |
| Hypereosinophilic syndrome: |
| This diagnosis is made if there is no demonstrable disease that could cause the eosinophilia, no abnormal T cell population, and no evidence for a clonal myeloid malignancy. |
| Chronic eosinophilic leukemia: |
| This diagnosis is made if all of the above exclusions have been met and if the myeloid cells demonstrate a clonal chromosomal abnormality, or are shown to be clonal by other means, or blast cells are present in the peripheral blood (> 2 percent) or are increased in the bone marrow (>5 to <19 percent of nucleated cells). |
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