An Unusual Case Of Smoldering Acute Myeloid Leukemia With Prolonged Indolent Clinical Course And Spontaneous Remission In The Terminal Phase
Marisavljevic, D., Markovic, O., & Zivkovic, R. (2009). An unusual case of smoldering acute myeloid leukemia with prolonged indolent clinical course and spontaneous remission in the terminal phase. Medical oncology (Norighthwood, London, England), 26(4), 476–479. https://doi.org/10.1007/s12032-008-9153-0
View Original Source →Abstract
An unusual case of acute myeloblastic leukemia (AML) with indolent clinical course and spontaneous remission in the terminal phase is described. A 63-year-old male has been diagnosed to suffer from AML, subtype M2. Chromosomal analysis showed 46,XY,del(6)(q21). Clinical course was slowly progressive ("smoldering" AML). The patient did not require cytoreductive drugs, and occasional supportive therapy was his only treatment. Five years from diagnosis patient exhibited spontaneous remission of the disease, accompanied with disappearance of del(6q) clone. Six months after, relapse occured and patient died from CNS bleeding. Additional curiosity in this case is the fact that patient's older brother died of acute lymphoblastic leukemia at the age of 71 years. Possible mechanisms of spontaneous remission of AML and genetic predisposition for human leukemia are discussed with a review of the literature.
Case Details
Disease Location
Bone marrow
Personal Characteristics
63 -year-old male records showed mild pancytoenia during routine blood analysis more than 2 years before admission his older brother died from hypatientoplastic b-all in april 2000 at 71 years old
Clinical Characteristics
Diagnosed with acute myeloid leukemia subtype m2 (smoldering acute myeloid leukemia) admitted in september 2002 for asymptomatic pancytopenia blood counts showed moderate pancytopenia differential blood count showed neutrophils 26%, lymphocytes 68 % exam of the bone marrow aspirate suggested acute myeloid leukemia, bone marrow was slightly hypocellular, hypoplastic erythroid and megakaryocytic series without dysplastic changes and 34% pox positive blasts were present pathohistological exam of marrow trephine biopsy showed hypoplastic acute myeloid leukemia with immunophenotype of blast cells mpo+, CD34+, CD117+ chromosomal analysis showed 46,xy,del(6)(q21) in 3/20 analyzed metaphases "watch and wait" was used and the patient was well until dec 2004 when he felt fatigued at that time, blood counts showed severe pancytopenia with differentials showing neutrophils 10%, and lymphocytes 88%. Bone marrow aspirate showed 52% of myeloblasts. Since then the patient required rbc transfusions eery 6 weeks in january 2007, blood count showed hemoglobin 120g/l, wbc 2.7x10^9/l (with 10% blasts), and platelet count 23x10^9/l severe anemia and thrombocytopenia required rbc and platelet transfusions patient died from cns bleeding in oct 2007, 7 years from first record of pancytopenia and 5 years from acute myeloid leukemia diagnosis
Remission Characteristics
In july 2006, his blood counts became normal, bone marrow showed hypercellular marrow with numerous mature megakaryocytes, erythroblast series constitute 39% of all nucleated cells, g-line was slightly dysplastic cytogenetic analysis showed normal karyotype (46,xy) sr of the disease lasted less than 6 months
Treatment & Mechanisms
Proposed Remission Mechanisms
No major mechanism proposed however, it is mentioned that sr may be associated with blood transfusions or infections, but the patient was receiving transfusions for almost 2 years before the sr, so remains unlikely
Clinical Treatment
Tranfusions
Non-Clinical Treatment
None reported