Spontaneous Remission In Acute Lymphocytic Leukaemia: Case Report
Journal of the Irish Medical Association 72(8): Aug 31 1979; 335-337
View Original Source →Abstract
A spontaneous complete remission of 17 months duration was observed in a patient with acute myelogenous leukemia. Resolution of all clinical and morphologic abnormalities occurred. The remission was apparently associated with an acute pulmonary infection. At relapse, remission induction was accomplished with cystosine arabinoside and daunorubicin therapy. In-vitro granulocyte-macrophage agar culture studies (CFU-c) showed an abnormal growth pattern at presentation, which persisted during the period of spontaneous remission. Reports of spontaneous remissions of acute myelogenous leukemia in adults have become increasingly rare, and the remissions themselves are short-lived. Despite the association between spontaneous remissions and acute infections or febrile episodes, attempts at remission induction with infectious agents have been unsuccessful. Spontaneous remissions are an uncommon variant of the natural course of acute myelogenous leukemia in the adult.
Case Details
Personal Characteristics
Seven-year-old girl
Clinical Characteristics
Pancytopenia, anorexia, malaise, bleeding tooth socket, pale, ecchymoses on both lower limbs, precordial systolic murmur, temperature of 100°f, no lymphadenopathy or splenomegaly, haemoglobin of 2.6 gm/dl, white cell count of 1,100/mm3, platelet count of 11,000/mm3, 90% lymphocytes (many atypical) and 10% neutrophils in peripheral blood film, no blast cells, normal urea, electrolytes, vitamin b12, folate, serum iron and iron-binding capacity and coagulation studies, negative cultures of urine, faeces and blood, splenomegaly in chest x-ray, marked marrow hypercellularity, areas of normal red blood cell and platelet precursors with foci of immature white cells in marrow biopsy, haemoglobin of 10.7 gm/dl, white cell count of 1,900/mm3, platelet count of 41,000/mm3 after thirteen days, normocellular marrow with an e:g ratio of 1.3, erythropoiesis was megaloblastoid, granulopoiesis was left shifted, atypical megakaryocytes, no evidence of leukaemia, normal blood counts after discharge, re-admission with history of bruising and malaise, temperature of 101°f, areas of purpura and petechiae on both lower limbs, slight lymphadenopathy in cervical, axillary and inguinal areas, spleen palpable two centimetres below the left costal margin, grade ii pansystolic cardiac murmur, haemoglobin of 7.8 gm/dl, white cell count of 31,000/mm3, platelet count of 37,000/mm3, 100% lymphocytes in peripheral blood film, majority of which were lymphoblasts, normal or negative other studies, throat swab grew haemolytic streptococcus, group a, markedly hypercellular marrow with all normal elements replaced by lymphoblasts in marrow aspiration
Remission Characteristics
Her peripheral blood and bone marrow pictures returned to normal and the blood remained normal for four and a half months
Treatment & Mechanisms
Proposed Remission Mechanisms
Not discussed
Clinical Treatment
Supportive therapy alone, transfused with blood and platelets, placed on gentamicin and carbenicillin
Additional Notes
It is considered that acute lymphocytic leukaemia was present initially and that it underwent spontaneous remission