Spontaneous Remission In Adult Acute Myeloid Leukemia In Association With Systemic Bacterial Infection-case Report And Review Of The Literature
Maywald, O., Buchheidt, D., Bergmann, J., Schoch, C., Ludwig, W. D., Reiter, A., Hastka, J., Lengfelder, E., & Hehlmann, R. (2004). spontaneous remission in adult acute myeloid leukemia in association with systemic bacterial infection-case report and review of the literature. Annals of hematology, 83(3), 189–194. https://doi.org/10.1007/s00277-003-0741-y
View Original Source →Abstract
Spontaneous remission of acute myeloid leukemia in the adult is a rare event. We report on a 31-year-old male patient suffering from acute myeloid leukemia (AML) M5a according to the French-American-British (FAB) classification with biphenotypic features in flow cytometric examination and severe bacterial infection with group G streptococci at the time of diagnosis. Because of sepsis and stable clinical conditions, chemotherapy was delayed and antibiotics were administered intravenously. Within 6 weeks a spontaneous remission of AML occurred. Remission lasted for about 2 months. At the time of relapse, a change in phenotype of the leukemic blasts with a loss of B-lymphoid markers could be demonstrated by flow cytometry. The patient was treated with an induction therapy according to the multicentric German AMLCG 2000 schedule. To our knowledge, this is the first report of a spontaneous remission in an AML FAB M5a associated with coexpression of myeloid- and lymphoid-associated antigens on the leukemic blasts. Possible mechanisms of this phenomenon are discussed with a review of the literature.
Case Details
Disease Location
Bone marrowithblood
Personal Characteristics
31 -year-old male
Clinical Characteristics
Acute myeloid leukemia admitted with a fever, large erysipelas on the left leg, pharyngitis, and headache blood cultures revealed bacteremia of group g strepatientococci antistrepatientolysin 0 level was strongly elevated, coagulation profile showed signs of disseminated intravascular coagulation with highly elevated d-dimer levles c-reactive protein levels were elevated, hemoglobin was 10.5g/dl, wbc was 1.2x10^9/l, platelets were 9.8x10^9/l. Differential blood count revealed 26% blasts bone marrow smear showed hypercellularity with 95% blasts with round nuclei blasts were strongly positive for nonspecific esterase staining confirming diagnosis of acute myeloid leukemia m5a immunophenotyping of marrow revealed expression of CD33, 65, 117 with coexpression of b-lymphoid markers cd79a and 19 as well as CD4 and 56 myeloid score was 3 and b-lymphoid score was 3 (egil), criteria of biphenotypic acute leukemia were fulfilled ultrasound found three left-sided inguinal lymph nodes up to 2 cm in diameter in context with erysipelas due to chronic septic conditions, chemo was delayed, antibiotics were administered via IV when the platelet count started to decrease 60 days after sr, bone marrow exam revealed relapse of acute myeloid leukemia with marrow infiltration of 80%, flow cytometry revealed co-expression of CD117, and 33, with CD4 and 7 chemo was administered fever of unknown origin in the period of post cytostatic pancytopenia was treated with IV antibiotics
Remission Characteristics
After IV antibiotics, fever and erysipelas slowly decrease, platelet count increased and d-dimer levels decreased on day 3 due to remission of dic, wbc decreased to a min of 0.3x10^9/l but unexpectedly started to increase after 4 weeks without occurrence of blasts in the differential blood count reevaluation by marrow aspiration 6 weeks after diagnosis of acute myeloid leukemia revealed normocellularity and remission of acute myeloid leukemia with <5% blasts in the marrow and no signs of hemophagocytosis in the marrow patient was referred to outpatient after complete clinical and hematological reconstitution blood counts were performed weekly, 30 days after confirmed remission, wbc decreased to 3.5x10^9/l without blast occurrence, wbc then stabilized. Platelet count started to decrease 60 days after sr. Bone marrow smear of day 16 after chemo revealed hypocellularity with a marked reduction of blasts complete remission of acute myeloid leukemia with reconstitution of normal peripheral blood counts and marrow was reached on day 26 after the start of induction chemo
Treatment & Mechanisms
Proposed Remission Mechanisms
May have been associated with bacterial infection
Clinical Treatment
IV antibiotics, starting with imipenem and continued with penicillin g, gentamicin, and vancomycin double induction chemo with high-dose cytarabine and mitoxantrone IV antibiotics for pancytopenia
Non-Clinical Treatment
None reported