Spontaneous Remission In Acute Leukemia; Report Of A Case Complicated By Eclampsia

Abstract

Acute leukemia in a 33-year-old woman had its onset in the seventh month of gestation. Symptoms of eclampsia developed, and she prematurely delivered a nonviable infant which showed no evidence of leukemia at autopsy. After delivery, she improved rapidly and was in good health for twenty-one months, whereafter again the clinical and hematologic picture of acute leukemia developed and the patient died. During the remission, cytologic evidence of leukemia in the sternal marrow and in the peripheral blood disappeared. The administration of radioactive phosphorus, in an attempt to induce a second remission, was followed by reduction in the leukocyte and thrombocyte counts without clinical evidence of improvement. The foregoing case exemplifies a unique form of acute leukemia which has been characterized by an acute febrile onset, frequent involvement of mucous membranes and less frequent splenomegaly and lymphadenopathy. Initially, severe anemia, leukopenia and thrombocytopenia are observed. There follows a remission, lasting as long as 21 months, characterized by apparent restoration of health, by disappearance of demonstrable lymphadenopathy and splenomegaly and by return of the peripheral blood and bone marrow pictures to normal or nearly normal. Suddenly, fever and other clinical manifestations of acute leukemia reappear; lymphadenopathy and splenomegaly, if previously present, return. The leukocyte count rises rapidly in most instances and evidence of acute leukemia in the peripheral blood and bone marrow is again apparent. Ideally, remissions induced by aminopterin (4-aminopteroyl glutamic acid) or by other means should simulate the spontaneous ones described.