spontaneous remission of acute lymphoblastic leukemia: A case report

Abstract

Spontaneous remission (SR) in acute lymphoblastic leukemia (ALL) is a rare phenomenon, but the disease course and its underlying processes are of basic and clinical interest. Herein is reported the case of a pregnant, 31-year-old patient who developed ALL, followed by septic shock and SR of ALL. Information is summarized from earlier case reports and incidences of SR in ALL, to identify common patterns. Furthermore, the phenomenon of SR is compared with another disease variant of ALL, termed prodromal or preceding-ALL (pre-ALL). SR and the aleukemic phase in pre-ALL are associated with fever and/or sepsis and have similar kinetics and epidemiology. Therefore, pre-ALL not only closely resembles SR in ALL, but both conditions may represent a single disease entity. Production of pro-inflammatory cytokines and immune cell effects may induce temporary remission of ALL and the suppression of hematopoiesis. In contrast to SR in other types of cancer, all documented cases of SR in ALL were only transient. However, the disease can still be effectively treated with standard ALL therapies following relapse.

Case Details

Disease Location

Blood

Personal Characteristics

Pregnant (gravida i, 30 weeks of gestation) 31-year-old female.

Clinical Characteristics

Admitted in april 2014 with severe anemia, progressive fatigue and excessive sweating. Hemoglobin concentration (hb) was 5.0 g/dl and the differential count indicated lymphocytosis and severe neutropenia. On an ambulatory visit two days later, enlarged cervical lymph nodes were noted and the complete blood count (cbc) indicated progressive leukocytosis. Based on the flow cytometry findings, a diagnosis of common‐all was determined. A total of 16 days following initial presentation, the patient was admitted with preterm uterine contractions, rupture of the membranes, fever, pancytopenia and elevated inflammation markers. After 8 weeks she presented with sinusitis, ldh was elevated to 958 u/l, the leukocyte count had increased to 31/nl with 50% atypical lymphocytes and hyperplasia of the adenoid tissue, associated with lymphoma. A diagnosis of all relapse was determined and all-specific therapy was started. Bone marrow biopsy verified complete molecular remission of all following induction therapy phase i.

Remission Characteristics

Simultaneously with clinical improvement, the patient's cbc and ldh began to normalize. Another 2 weeks later, no atypical lymphocytes were detectable on microscopic blood film examination, and flow cytometry demonstrated a decreased amount of CD45 low leukocytes. After 2 more weeks, flow cytometry of peripheral blood samples was negative for all.

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

Blood transfusion steroids cefuroxime and a short course of prednisone antibiotics and antifungal agents all-specific therapy

Non-Clinical Treatment

Treatment at a naturopathic clinic