spontaneous Remission in Acute Type Adult T-Cell Leukemia/Lymphoma

Abstract

Adult T-cell leukemia/lymphoma (ATL) is a neoplastic disorder of T lymphocytes associated with human T lymphotropic virus type I (HTLV-I). The prognosis of ATL is generally poor. We present here a 79-year-old woman with spontaneous remission of acute type ATL. Spontaneous remission was preceded by surgical biopsy and pneumonia and lasted for two years until she died with pancreas cancer. Monoclonal integration of HTLV-I provirus DNA became undetectable after remission.

Case Details

Disease Location

Lymph nodes (inguinal, para-aortic)

Personal Characteristics

79 -year-old female march 1997

Clinical Characteristics

Visited hospital due to leg edema and generalized ln enlargements biopsy of the inguinal ln in april 1997 showed difuse infiltration of pleomorphic lymphocytes peripheral leukocyte count was 11x10^9/l and 38% of them were lobulated lymphocytes flow cytometric analysis of peripheral leukocytes revealed accumulation of CD2+, CD3-, CD4+, CD8- and CD25+ cells. Serum lactate dehydrogenase level was elevated up to 740 iu/l, serum soluble interleukin-2 receptor was 94,503 u/ml abdominal CT showed enlargement of the para-aortic ln serum antibody against htlv-i was positive by western blot analysis; southern analysis found monoclonal integration of htlv-i provirus DNA in peripheral lymphocytes diagnosis of acute type atl was established aspiration pneumonia developed at that time and antineoplastic chemo could not be performed. IV imipenem improved pneumonia in several days after sr she was followed up until she complained of abdominal pain in oct 1998. CT of abdomen showed a large mass surrounding the head of pancreas and multiple low-intesnsity lesions in the liver atypical lymphocytes were not found in bone marrow and peripheral blood she died a few months later with multiple organ failure autopsy revealed adenocarcinoma of pancreas and metastasis to the liver. Residual atl cells were not observed

Remission Characteristics

After onset of pneumonia, surface lymph nodes began to decrease in size and had almost diminished at the end of may 1997 abdominal CT scan also showed disappearnace of the enlarge para-aortic lymph nodes peripheral atypical lymphocytes also decreased and disappeared by the end of june '97, flow cytometry in june showed recovery of normal t-cells and serum levels of ldh and sil-2r were almost normalized the monoclonal integration of htlv-i provirus DNA in peripheral lymphocytes became underightectable three months after sr

Treatment & Mechanisms

Proposed Remission Mechanisms

Both surgical biopsy and infection preceded sr, which may have triggered the sr through perhaps a immunological response

Clinical Treatment

IV imipenem for pneumonia

Non-Clinical Treatment

None reported