Remission of Chronic Lymphocytic Leukemia After Smallpox Vaccination

Abstract

A seven-year-old girl presented initially with pancytopenia and was treated with supportive therapy alone. Her peripheral blood and bone marrow pictures returned to normal and the blood remained normal for four and a half months. The haematological picture then relapsed and the diagnosis of acute lymphocytic leukaemia was established. It is considered that acute lymphocytic leukaemia was present initially and that it underwent spontaneous remission.

Case Details

Personal Characteristics

78-year-old man

Clinical Characteristics

Elevated peripheral lymphocyte count, diffuse infiltration of the femoral head with small lymphocytes, lymphocytic infiltration of the prostatic tissue, 1 x 3 centimeter inguinal nodes, bone marrow showing diffuse infiltration of small lymphocytes, generalized hypogammaglobulinemia, large pustular draining lesion with eschar and severe erythema, induration, and axillary adenopathy, generalized, maculopapular, nonvesicular rash, vasculitis, absolute lymphocyte count steadily fell and has remained within normal limits

Remission Characteristics

Leukocyte count fell to normal, all evidence of cll disappeared, remains in complete remission three years after smallpox vaccination, normal physical examination findings following regression of inguinal lymphadenopathy, normal bone marrow with scattered small benign appearing lymphoid nodules but no diffuse infiltration of lymphocytes

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

Treatment with vaccinia immune human globulin, 20 milliners of vaccinia immune human globulin was given intramuscularly

Non-Clinical Treatment

Smallpox revaccination

Additional Notes

The patient was first noted to have an elevated peripheral lymphocyte count in 1968. A diagnosis of CLL was made in 1973. The patient was revaccinated for smallpox in 1974. The patient remains in complete remission three years after the smallpox vaccination.