Cytogenetic And Hematological Spontaneous Remission In A Case Of Acute Myelogenous Leukemia
Fozza, C., Bellizzi, S., Bonfigli, S., Campus, P. M., Dore, F., & Longinotti, M. (2004). Cytogenetic and hematological spontaneous remission in a case of acute myelogenous leukemia. European journal of haematology, 73(3), 219–222. https://doi.org/10.1111/j.1600-0609.2004.00281.x
View Original Source →Abstract
Several cases of spontaneous remission (SR) interrupting the invariably progressive course of untreated acute myeloblastic leukemia (AML) have been reported so far. We shall add to this series the hematological and cytogenetic SR occurring in a 72-yr-old man affected by AML following myelodysplastic syndrome. At diagnosis cytogenetic analysis showed the 48, xy, del (6) (p22-pter), +13, +14 karyotype. Owing to a lobar pneumonia, the chemotherapy was deferred and a broad spectrum antibiotic therapy was established. Supportive care included red cells and platelet transfusions and low-dose corticosteroid. Two months later, after the pneumonia had completely disappeared, a complete remission, lasting about 5 months, was documented on bone marrow morphological and cytogenetical examination, although some degree of myeloid dysplasia persisted. Possible mechanisms of the various SRs described during the course of AML are discussed with a review of the literature.
Case Details
Disease Location
Bone marrowithblood
Personal Characteristics
72 -year-old male long-lasting moderate pancytopenia
Clinical Characteristics
April 2002 patient was diagnosed with refractory anemia 7 months later (nov 2002) patient was admitted with high-grade fever and worsening pancytopenia chest x-ray showed a lobar infection in the right lung coagulase-negative staphylococcus and a candida spp, were isolated on sputum cultural analysis and broad-spectrum antibiotic therapy was established significant lab data included severe anemia, leukopenia, thrombocytopenia marrow was hypercellular and contained almost 100% small and medium sized blasts cells with a poorly granulated cytoplasm flow cytometry found leukemic cells turned out to be positive for CD13, 34, 45, HLA-dr cytogenetic analysis showed in 17/17 observed metaphases the 48, xy, del (6)(p22-patienter), +13, +14 karyotype diagnosis of secondary acute myeloid leukemia supportive care included re cells and platelet transfusions and low-dose corticosteroid in june 2003, a hematological relapse occurred leukocyte count rose to 131,000/mcl with about 90% circulating blast cells, hgb was 7.9g/dl, and platelet was 53,000/mcl, cytochemistry and flow cytometry were identical to those performed at diagnosis july 2003, one month later the patient while being on hydroxyurea therapy died of massive pneumonia
Remission Characteristics
2 months later (jan 2003) the pneumonia had completely disappeared on chest x-ray complete remission (<5% blasts) was found in the bone marrow exam, although some degree of myeloid dysplasia persisted. The karyotype turned out to be normal in 15/15 metaphases 5 months later, relapse occured
Treatment & Mechanisms
Proposed Remission Mechanisms
A cross-activated immunity controlling the leukemic clone as well as an antileukemic effect of transfused leukocytes patient received irradiated packed red cell sr may be associated with the role of the steroid, although not much empirical evidence to supporight
Clinical Treatment
Broad spectrum antibiotics (cephalosporis and aminoglycosides then 2 weeks later replaced by imipenem, teicoplanine, and amoxycilin) transfusions and prednisone hydroxyurea
Non-Clinical Treatment
None reported