Spontaneous Remission Of Acute Myeloid Leukemia Relapse After Hematopoietic Cell Transplantation In A High-risk Patient With 11q23/mll Abnormality
Hudecek, M., BARTsch, K., Jäkel, N., Heyn, S., Pfannes, R., Al-Ali, H. K., Cross, M., Pönisch, W., Gerecke, U., Edelmann, J., Ittel, T., & Niederwieser, D. (2008). spontaneous remission of acute myeloid leukemia relapse after hematopoietic cell transplantation in a high-risk patient with 11q23/MLL abnormality. Acta haematologica, 119(2), 111–114. https://doi.org/10.1159/000121827
View Original Source →Abstract
A 35-year-old female patient was diagnosed with acute myeloid leukemia with multiple genetic aberrations [48 XX, del(3)(q21), +6, t(11;15)(q23;q15), +21] including an 11q23/MLL abnormality. The patient achieved a complete remission after one induction chemotherapy cycle. After three courses of consolidation, a matched unrelated hematopoietic cell transplantation (HCT) was performed. Following an upper respiratory tract infection 7 years after transplant, her blood counts declined to leukocytes of 1 x 10(9)/l, platelets of 51 x 10(9)/l and hemoglobin of 7.5 g/dl. A bone marrow aspirate revealed 55% leukemic blasts carrying the unfavorable genetic aberrations seen at initial diagnosis (11q23/MLL). In the absence of any disease-specific treatment, the leukemic blasts cleared from the bone marrow within 6 days after diagnosis of relapse and peripheral blood counts returned to normal. Molecular analysis of the 11q23/MLL rearrangement was used to evaluate minimal residual disease, which became undetectable in repetitive FISH analyses. This is the first report of spontaneous remission in a patient with initially a multiaberrant leukemic cell clone and a proven 11q23/MLL abnormality at relapse after HCT.
Case Details
Disease Location
Blood
Personal Characteristics
35 years old caucasian lady
Clinical Characteristics
4 weeks history of progressive general weakness, nocturnal sweating and subfebrile t. No symptoms of acute infection or hemorrhage. Skin rash after taking metamizol. Blood count: leukocytes 2x10*9/l, platelets 495 x 10*9/l, hemoglobin 12.4 g/dl. 13% neutrophils, 78% lymphocytes, 5% monocytes, 4% blasts and marked granulocytopenia. Acute myeloid leukemia diagnosed. After hct, patient developed acute graft-versus-host disease (gvhd) and pneu months. 7 years after hct, the patient suffered from a respiratory infection. 55% leukemic blasts developed, donor cell chimerism in the marrow decreased to 73%. Relapse confirmed.
Remission Characteristics
Complete remission achieved after one induction course. 6 days after relapse and treatment, patient showed a persistent cr
Treatment & Mechanisms
Proposed Remission Mechanisms
Infection-related immunosuppression can lead to relapse of the leukemia, while subsequent recovery of immune function can restore remission.
Clinical Treatment
Chemotherapy (cytarabine 2 g/m*2) on days 1,3, 5, 7 and idarubicin 12 mg/m*2 on days 1-3 in june 1999. Another chemotherapy between july and november 1999, maintaining cr. In january 2000 she underwent allogeneic hematopoietic cell transplantation (htc). After developing gvhd, patient was treated with corticosteroids and puva therapy, along with antibiotics to treat pneumonia. 28 days after transplant, patient showed cr. 7 years after, patient developed an infection, thus treated with antibiotics. Relapsed confirmed, thus treated with leukodepleted, irradiated packed red cells and irradiated platelets.