Spontaneous Remission In Acute Myeloid Leukemia: A Case Report
Adam, M., & Eltayeb, A. (2014). spontaneous remission in acute myeloid leukemia: A Case report. The Gulf journal of oncology, 1(15), 84–86. https://doi.org/10.1007/bf00320532
View Original Source →Abstract
Spontaneous remissions (SRs) in acute myeloid leukemia (AML) are infrequent, poorly documented and transient. Similarly, morphological and cytogenetic complete remissions (CR) under azacitidine treatment are scarce. We report a 71-year-old man with a secondary AML arising from essential thrombocythemia (ET), who developed an SR after discontinuation of azacitidine following a respiratory infection (four courses were administered). The distinctive feature of our case is the depth of the achieved CR, documented by next-generation sequencing (NGS) techniques. We also detected persistence of molecular lesions that might already have been present in the previous ET clone. Our patient relapsed 5 months after achieving CR. We conclude that our patient showed a spontaneous remission of his AML rather than an exquisite response to azacitidine. We hypothesize that the concurrent respiratory infection, or any other unknown trigger, might have activated his immune system forcing the leukemic stem cell to enter a quiescent state through a yet unexplained mechanism.
Case Details
Disease Location
Blood/bone marrow
Personal Characteristics
35-years old male
Clinical Characteristics
Presented in jan 2011 with fever, oral thrush and bleeding gums, generalized lymphadenopathy and hepatosplenomegaly ultrasound examination of the abdomen revealed enlarged spleen 15cm and liver 14cm with no focal lesions bone marrow examination confirmed the diagnosis of acute myeloid leukemia (m4). The bone marrow was extremely hypercellular and replaced by myeloblasts, there were eosinophils with abnormal granulations; the other hematopoietic precursors were scanty. Three weeks after diagnosis, then sharply reduced to 2.0x109/l five days later. Subsequently the patient developed febrile neutropenia and received the corresponding management. 6 weeks later the patient presented with relapse and chemotherapy was started immediately
Remission Characteristics
Bone marrow examination showed hematological remission, granulopoiesis was active with orderly maturation, erythroid was normoblastic, megakaryocytes were adequate and blasts were 2-3% (after febrile neutropenia). The duration of spontaneous remission in the present case was about six weeks.
Treatment & Mechanisms
Proposed Remission Mechanisms
Immune response and blood transfusion
Clinical Treatment
Blood and platelet transfusion, broad spectrum antibiotics and antifungal treatment granulocyte colony stimulating factor (for febrile neutropenia) daunorubicin and cytarabine (chemotherapy)