Spontaneous Complete Remission In A Patient With Acute Myeloid Leukemia And Severe Sepsis
Mozafari, R., Moeinian, M., & Asadollahi-Amin, A. (2017). spontaneous Complete Remission in a Patient with Acute Myeloid Leukemia and Severe Sepsis. Case reports in hematology, 2017, 9593750. https://doi.org/10.1155/2017/9593750
View Original Source →Abstract
Without treatment, acute myeloid leukemia (AML) is almost always fatal. Spontaneous remission of AML is a rare phenomenon and usually with a short duration. The exact mechanisms are unknown. However, its association with infection and blood transfusions has been described. We report a 53-year-old male who presented with severe sepsis and who was diagnosed with AML (M4). He has experienced complete spontaneous remission with relatively long duration. To the best of our knowledge, it is the first case of spontaneous remission described in Iran.
Case Details
Disease Location
Bone marrowithblood
Personal Characteristics
53-year-old male
Clinical Characteristics
Presented with severe dyspnea, chest pain, productive cough, and dizziness. Chest x-ray revealed bilateral infiltrative abnormalities. He was transferred to icu due to respiratory distress, and mechanical ventilation started. Bone marrow aspiration smear revealed 70%–80% cellularity with reduced megakaryocytes and raised ratio of myeloid to erythroid cells. He was diagnosed with acute myeloid leukemia-m4. Culture of tracheal discharge was positive for enterobacter spp. And acinetobacter baumannii. Blood culture result was klebsiella pneumonia. Two weeks later, the infections completely resolved and he was weaned off the ventilator.
Remission Characteristics
Two weeks after sepsis resolution the bone marrow smear contained 5–10% cellularity with adequate megakaryocytes for this setting, myeloid and elytroid cells being in various maturation phases, and no blasts were recognized. Two weeks later, the bone marrow biopsy was repeated and the smear revealed 50–60% cellularity with sufficient megakaryocyte, the normal ratio of myeloid to erythroid cells, and no blast
Treatment & Mechanisms
Proposed Remission Mechanisms
Infections and blood transfusion lead to immune activation
Clinical Treatment
Broad-spectrum antibiotics and antifungal drug (not specified), blood transfusion, low-dose dexamethasone