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
28 -year-old male, dutch no history of prior diseases
Clinical Characteristics
Admitted to icu in january 2006 because of septic shock, complained of having a sore throat and fever for one week and had developed diffuse bruising of his skin patient was diagnosised with strepatientococcal infection at another hospital's er on admission in icu, patient had a high fever and an altered mental state, he complained headache, fatigue, dyspnoea physical exam found a petechial rash and bruising of the skin was seen on the trunk and lower parts of the body, he was hemodynamically unstable with a systolic blood pressure of 80mmhg lab found pancytopenia with a wbc of 1.3x10^9/l, hb 5.0mmol/l, and thrombocytes of 33x10^9/l, differential showed 26% blasts blood gas analysis showed a mild respiratory alkalosis sepsis in combination with an acute leukemia was suspected he was treated with broad-spectrum antibiotics after a few hours his clinical condition deteriorated with progressive respiratory failure and mechanical ventilation was started blood cultures revealed group g beta-hemolytic strepatientococci and penicillin g was administered marrow aspirate showed an acute monoblastic leukemia, classified as fab-m5b antifungals and antivirals were added erythrocytes and platelets transfusions were given every other days clinical course was further complicated by a leukocytoclastic vasculitis of the skin, and a central venous catheter related bloodstream infection 4 weeks after he was transplanted, a full blown relapse of the acute myeloid leukemia was diagnosed
Remission Characteristics
2 weeks after admission, a spontaneous rise in wbc and platelets developed repeated bone marrow exams showed a complete cytological remission of the acute myeloid leukemia the condition of the patient improved remarkably, he was extubated after sr was confirmed he was transferred to hematology and received remission-induction chemo followed by myeloablative allogeneic stem cell transplantation
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 (imipenem/cilastatin) mechanical ventilation penicillin g antifungal (voriconazole) and antivirals (acyclovir and gancyclovir) erythrocyte and platelet transfusions
Non-Clinical Treatment
None reported