Hematologic and Cytogenetic spontaneous Remission in Acute monocytic Leukemia (FAB M5b) With Trisomy 8

Case Details

Disease Location

Bone marrowithblood

Personal Characteristics

83 -year-old female caucasion

Clinical Characteristics

Presented with generalized pain, weakness, and anorexia for 4 days lab worked showed wbc of 43.6x10^9 with 14% bands, 46% neutrophils, 3% lymphocytes, 33% monocytes, and 1% eosinophils. Hemoglobin was 12.9g/dl, and platelet count was 52x10^9/l peripheral blood smear showed monocytosis and occasional atypical monocytes ua showed 10-50 wbcs and 2+ occult blood as well as a small amount of bacteria tentative diagnosis of uti bone marrow biopsy and aspiration was scheduled, further lab tests showed lactate dehydrogenase 1,283u/l, d-dimer was 8,061ng/ml ultrasound of the abdomen showed splenomegaly bone marrow aspirate demonstrated marked impairment of trilineage hematopoietic activity 60% of nucleated cells were comprised of blasts and pro monocytes the bone marrow biopsy demonstrated similar histologic findings with cellularity greater than 90%, the bulk of cellularity constituting an estimate of more than 60% of cells blasts were butyrate esterase positive flow cytometry performed on the bone marrow revealed a blast population that expressed CD33, 11c, 13, 14, 15, HLA-dr class ii, major histocompatibility complex antigen. Cytogenetics revealed an abnormal 47, xx, +8[20] karyotype diagnosis of acute myeloid leukemia with a monocytic variant (fab m5b) was made chemo was withheld, supportive care was initiated and included transfusions of leukoreduced irradiated packed rbcs and leukoreduced irradiated platelets, blood count was checked biweekly and blood and platelet transfusions were received as needed after 10 day levofloxacin, urine culture showed a distal urethral contaminant 2 weeks after complete remission, the patient developed multiple skin lesions on the left breast

Remission Characteristics

Her platelet count, hemoglobin and wbc count improved progressively 2 and a half months after diagnosis cbc yielded the following results: platelet count 190x10^9/l, hemoglobin 11.3g/dl, and wbc 2.25x10^9/l (57% neutrophils, 19% lymphocytes, 22% monocytes, and 2% eosinophils bone marrow aspiration and biopsy as well as flow cytometry showed no residual evidence of acute myelogenous leukemia. Cytogenetics revealed a normal 46, xx, [20] karyotype complete spontaneous hematologic and ctyogenetic remission

Treatment & Mechanisms

Proposed Remission Mechanisms

There may be some correlation to infection and blood transfusion (however this patient likely did not have an infection and the transfusion given was irradiated and leukocyte depleted)

Clinical Treatment

Was given IV fluid and levaquin IV for tentative uti supportive care was initiated and included transfusions of leukoreduced irradiated packed rbcs and leukoreduced irradiated platelets patient finished a 10 day course IV levoflaxacin

Non-Clinical Treatment

None reported