Spontaneous Regression of Cytogenetic and Hematologic Anomalies In Ph1 Positive Chronic Myelogenous Leukaemia

Abstract

“Spontaneous” complete remissions (SCR) are a rare event in chronic lymphocytic leukemia (CLL). In this article, we report three cases of SCR observed in a series of 285 patients followed at a single institution during the last 15 years. SCR was documented by clinical and hematologic data, including bone marrow biopsy, and immune cell markers. A delay of 0.9-1.6 years between “clinical” and “clonal” remission was observed. A review of other cases of SCR in CLL is also performed.

Case Details

Personal Characteristics

27-year-old man with a possible history of professional benzene exposure

Clinical Characteristics

Mild leukocytosis, wbc was 12.2 x 109/l with polymorphonuclears 58%, eosinophils 5%, basophils 2%, lymphocytes 16%, monocytes 13% and myelocytes 6%. Erythrocytes and platelets were normal. Splenomegaly was absent. Laboratory findings demonstrated a myeloproliferative disorder with bone marrow aspirate and biopsy showing hyperplasia of granulocytes with normal maturation and a slight eosinophil increase. Megakaryocytes appeared normal, erythroblasts were moderately decreased and fibrosis was absent. Karyotype examination showed the ph1 chromosome.

Remission Characteristics

Progressive regression of haematologic and cytogenetic data was observed. Eight years after diagnosis the karyotype showed only 37% ph1 positive cells and the trisomy 8 had disappeared.

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

Regular follow-up without therapy

Additional Notes

Three phases were observed during the course of the disease. The first lasted about 3 years and was characterized by stable haematological and cytogenetic condition. The second ran from 1981 to 1983 and showed progressive haematological and cytogenetic regression. The third phase began in 1983 and was characterized by a cytogenetic stabilization.