Complete Spontaneous Regression Of Chronic Lymphocytic Leukemia
Herishanu, Y., Solar, I., Ben-Ezra, J., Cipok, M., Meirsdorf, S., Amariglio, N., Hoffman, S., Kay, S., Aharon, Z., Perry, C., Polliack, A., & Naparstek, E. (2012). Complete spontaneous regression of chronic lymphocytic leukemia. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 30(26), e254–e256. https://doi.org/10.1200/JCO.2011.40.7536
Case Details
Disease Location
Lymph nodes
Personal Characteristics
54 -year-old man in 2003
Clinical Characteristics
Chronic lymphocytic leukemia (cll) patient complained of fatigue and malaise physical revealed bilateral cervical and axillary lymphadenopathy with the largest node measuring 2x3cm biopsy of the enlarged left axillary ln showed replacement of the normal nodal architecture by a diffuse infiltration of mostly small lymphocytes with clumped chromatin and inconspicuous nucleoli ihc stains for CD20 and 23 were positive, ki-67 staining showed a low proliferative index biopsy findings were consistent with b-cell small lymphocytic lymphoma/cll cbc showed a leukocyte count of 9.9x1-^9/l with 6x10^9/l lymphocytes, a hemoglobin concentration of 15g/dl, and 194x10^9 platelets peripheral blood smear was compatible with cll and showed increased numbers of small typically mature lymphocytes and basket cells flow cytometry of peripheral blood detected monoclonal b cells which were positive for CD19, 5, 20, 23 and k light chains. CT of the chest and abdomen showed prominent bilateral axillary, inguinal and retroperitoneal lymphadenopathy PET/CT demonstrated pathologic uptake in enlarged lymph nodes on both sides of the neck and axilla as well as in the retroperitoneum and pelvis with the largest ln measuring 3.7x2cm patient was diagnosed as having cll rai stage i and was routinely followed in the clinic with no treatment trephine marrow biopsy found cll in a nodular and interstitial pattern (fig 2a) lymphoid cells were positive for CD20 and only scattered t cells were present
Remission Characteristics
Article states a complete regression of cll during a followup period of 36 months, the lymph nodes regressed and 3 years later, on july 2007, the physical exam was totally normal, no palpable lymph nodes were found cbc showed a leukocyte count of 4.78x10^9/l with only 1.9x10^9/l lymphocytes, a hemoglobin concentration of 14.3g/dl, and 145x10^9/l platelets. In oct 2010, CT showed regression of all previously enlarged lymph nodes fig 1a in article shows regression in the aorightocaval and para-aortal region during the same period, there was no cll evident on a repeated bone marrow biopsy, scattered lymphoid aggregates were present within a normal hematopoietic marrow. Lymphoid cells in the aggregate were positive for CD3 cll clone was failed to be detected by four-color fluorescence-activated cell sorighter polymerase chain reaction showed that the original malignant clone at diagnosis was still detected in the bone marrow at follow-up a sequence analysis of the monoclonal cells at follow-up was complementary to the original clone studied at diagnosis, however blood and bone marrow aspiration at followup revealed that the b cells were polyclonal
Treatment & Mechanisms
Proposed Remission Mechanisms
Possible role for cancer immune-surveillance in the promotion of regression in clinically over malignant disease possible links in previous reports include suggestions of associations with smallpox immunization, antihypertensive therapy including calcium channel blockers, intake of green tea and the development of secondary malignancy
Clinical Treatment
None reported
Non-Clinical Treatment
None reported