Case of adult T-cell leukemia resulting in spontaneous remission and pancytopenia

Case Details

Disease Location

Bone marrowithblood

Personal Characteristics

88 -year-old female japanese

Clinical Characteristics

Adult t-cell leukemia diagnosis with chronic type and pancytopenia referred on oct 1996 after a screening showed an increased white blood cell count wbc was 35,900/ul, monocytes 1.0%, atypical lymphocytes with lobulated nuclei 47.5%, antibody against htly-i was positive she was observed without chemotherapy because of no complaints and age in april 1999, bone marrow smear revealed hypocellular marrow with an increased number of apoptotic cells, which was also confirmed by tunnel array cytogenetic study of bone marrow cells revealed 46, xx. Biochemical studies revealed crp 0.3mg/dl, alb 3.2g/dl, glb 2.0g/dl, IGG 651mg/dl, IGA 30mg/dl, IGM 29mg/dl, bilirubin 0.9mg/dl, got 5iu/l, gpatient 9iu/l, ferritin 631 ug/l, b2m 2.5mg/dl cytokine levels in the serum: soluble IL-2 receptor 198000u/ml, TNF-alpha <5pg/ml, ifn-lambda 0.7iu/l and IL-2 <0.8u/ml lymphocyte subset of the peripheral blood revealed CD3 92.3%, CD4 69.8%, CD8 23.7%, and HLA-dr 77.8% the monoclonal integration of the htlv-i proviral DNA was faintly observed two-color flow cytometry of marrow revealed 73.2% of cd95+CD34- cells anti parvovirus b19 IGG, anti bb virus vca IGG, bbna, and anti cmv IGG were positive she was treated with prednisolone and periodic rbc and platelet transfusions

Remission Characteristics

In april 1999 wbc was 3900/ul, atypical lymph 3.0%, platelets was 59000 as of january 2000, she is without relapse of leukemia or other complications, the necessity of transfusions was decreasing

Treatment & Mechanisms

Proposed Remission Mechanisms

Indication that atl cells and hematopoietic cells were vulnerable to apoptosis by increased activity of fas-mediated apoptosis

Clinical Treatment

Prednisolone and transfusions of rbc and platelets

Non-Clinical Treatment

None reported