spontaneous remission of acute myeloid leukemia associated with GnRH agonist treatment

Abstract

Spontaneous remission of acute myeloid leukemia (AML) in adults is a rare but well documented phenomenon. This study reports on a 64-year-old male patient with acute myelogenous leukemia (AML-M4, according to the French-American-British classification) that was developed on a background of chronic myelomonocytic leukemia (CMML) and then underwent remission after treatment with the gonadotropin-releasing hormone agonist (GnRH agonist) triptorelin for presumed prostate cancer. Remission persisted for at least 4 years before the patient was lost to follow-up. To the author' knowledge, this is the first report of remission in an AML-M4 case associated with hormone manipulation. Possible mechanisms of this phenomenon are discussed.

Case Details

Disease Location

Bone marrowithblood

Personal Characteristics

64 -year-old male 2 year history of mild anemia, monocytosis, and thrombocytopenia history also significant for diet-controlled diabete mellitus he was a former smoker and drinker

Clinical Characteristics

Patient presented with complaints of fatigue, increased suscepatientibility to infections, diffuse bone aches and pruritus, especially in lower extremities physical only revealed a mild splenomegaly and prostatic hypertrophy cbc showed wbc 22x10^9/l (lymphocytes 18%, monocytes 25%) and a platelet count of 55x10^9/l, rbc sedimentation rate was 7mm in 1h abdominal CT showed mild hepatomegaly and splenomegaly prostate was slightly enlarged bone scanning showed increased uptake throughout the axial skeleton suggesting secondary metastatic deposits bone marrow was hypercellular, there was a relative suppression of the erythroid lineage, hypogranulation and hypo-segmentation of granulocytic precursors, decreased number of megacaryocytes and a blast count of 10% trephine biopsy showed suppression of the adipose tissue, diffuse mild myelofibrosis diagnosis ofmyelomonocytic leukemia was made a months later, repeat marrow biopsy showed progression of cmml to acute myeloid leukemia-m4 as the blast cells occupied more than 35% of the marrow cell population these blast cells were stained positive for CD15, 68 and lysozyme, consistent with a cell infiltrate ofmyelomonocytic lineage during the bone marrow analysis, patient was prematurely placed on tripatientorelin

Remission Characteristics

After triptorelin, the patient experience significant symptomatic relief with improvement of his skeletal complaints and his sense of well-being prostate cancer was ruled out and his wbc decreased and platelet count increased, watch-and-wait was adopted he received im triptorelin once a month re-evaluation of marrow 5 months later showed that the blast cells had decreased at least 50% compared to previous test *figure 2 shows progression of the peripheral blood monocytosis over time and in association with triptorelin* patient discontinued triptorelin 1 year later because of ed and refused a new marrow biopsy at the last telephone follow-up almost 4 years later, he was alive and his hematologic profile resembled the one prior to the establishment of the acute myeloid leukemia diagnosis

Treatment & Mechanisms

Proposed Remission Mechanisms

Hormonal factors may be responsible i.e. The gnrh agonist these medications initially produce a rise in luteinizing hormones and follicle-simulating hormones, followed by a down-regulation of receptors in the pituitary gland, which effects a chemical castration; a hematopoietic cell line with abundant hormones receptors could theoretically be suscepatientible to hormonal treatment inter-play of hematopoietic and endocrine systems

Clinical Treatment

Triptorelin (gonadotropin-releasing hormones agonist; gnrh agonist)

Non-Clinical Treatment

None reported