Spontaneous Remission Of Acute Myeloid Leukaemia After Recovery From Sepsis
Trof, R. J., Beishuizen, A., Wondergem, M. J., & Strack van Schijndel, R. J. (2007). spontaneous remission of acute myeloid leukaemia after recovery from sepsis. The Netherlands journal of medicine, 65(7), 259–262. https://doi.org/10.48095/cctahd2025prolekare.cz20
View Original Source →Abstract
Spontaneous remission of acute myeloid leukaemia (AML) is extremely rare and usually of short duration. We report two patients with documented AML who developed spontaneous remission of their leukaemia shortly after an episode of severe sepsis and respiratory failure requiring mechanical ventilation. The underlying mechanisms of spontaneous remission remain unclear but an association with preceding blood transfusions and severe systemic infections has been reported. An overwhelming immune response due to sepsis and leading to raised levels of TNF-alpha, INF-gamma, IL -2 and an increased activity of NK cells, cytotoxic T-cells and macrophages are thought to play an important role. Better insights into the mechanisms of spontaneous remission of AML after recovery from sepsis could help in developing new therapies for AML.
Case Details
Disease Location
Bone marrowithblood
Personal Characteristics
29 -year-old male, iraqi
Clinical Characteristics
Transferred in september 1997 for suspected acute myeloid leukemia lab results showed a mild leukocytosis with 21% blasts marrow biopsy showed acute myeloid leukemia classified as fab m2 cytogenetic analysis of marrow demonstrated a t(8;21) translocation and deletion of the y chromosome 2 days after admission, a superimposed infection was suspected and was treated with broad-spectrum antibiotics after 3 days, progressive respiratory failure developed, showing bilateral infiltrative abnormalities on a chest x-ray, mechanical ventilation was started in the icu antifungals and antivirals were added to the broad-spectrum antibiotics patient was intermittently ventilated for 2 weeks, ventilation was complicated twice by an acute tension pneumothorax tests showed a persistent pancytopenia required erythrocytes and platelets transfusion clinical condition deteriorated over time with development of severe cachexia and the picture of an ongoing sepsis after sr, 3 months later, pcr showed the presence of (8;21) translocation and after 6 moths, marrow exam showed a cytological relapse of acute myeloid leukemia during the second induction chemo according to hovon protocol, the patient died of a massive intracranial hemorrhage
Remission Characteristics
3 weeks after admission to the icu, wbc and platelet count spontaneously started to rise and the patient's clinical condition improved and weaned off the ventilator follow by extubation repeated bone marrow exam showed a hypercellular bone marrow with no blast presence, suggesting cytological remission of acute myeloid leukemia cytogenetics confirmed a normal karyogram without t(8;21) translocation and the presence of a normal y chromosome a few days later he was transferred to hematology and repeated marrow exams showed persistent cytological remission which was confirmed by polymerase chain reaction
Treatment & Mechanisms
Proposed Remission Mechanisms
The presence of a severe systemic inflammation could have played an imporightant and possibly a causal role in sr overwhelming sepsis leading to an exuberant activation of the immune system may cause containment of leukemia further details in article
Clinical Treatment
Antibiotics for infection (cefpirom) mechanical ventilation antifungal (itraconazole) and antiviral (acyclovir) were added to antibiotics (imipenem-cilastation) transfusions hovon protocol chemo
Non-Clinical Treatment
None reported