Spontaneous Remission Without Treatment Of Acute Myelomonocytic Leukemia Associated With Covid-19 Infection
Peñuela, R., Hernandez, I., Fernandes-Pineda, M., Cortina, L., Zapata, D., Urrego, O., Herrera, J., Saenz, I., Orduz, R., Mejia, F., Moreno, L., & Velazco, M. (2024). Spontaneous remission without treatment of acute myelomonocytic leukemia associated with COVID-19 infection. Hematology, transfusion and cell therapy, 46(4), 506–510. https://doi.org/10.1016/j.htct.2023.11.004
View Original Source →Case Details
Disease Location
Blood
Personal Characteristics
25-year-old woman, history of a convulsive syndrome attributed to a poroencephalic cyst.
Clinical Characteristics
Symptoms of abdominal pain, non-dysenteric diarrhea, fever, and seizures. She reported experiencing hyporexia and unquantified weight loss for the past six months. On the second day of hospitalization, she developed a fever with suspected sepsis of gastrointestinal origin. Peripheral blood smear showed monocytoblasts with the presence of auer rods and monocytosis. Peripheral blood flow cytometry provided an immunophenotypic diagnosis of acute myelomonocytic leukemia (aml). On day 11, in preparation for induction chemotherapy, wisdom tooth removal was complicated by an abscess that required drainage and debridement of the granulomatous tissue. By day 17, her bone marrow failure worsened, leading to febrile neutropenia. Broad-spectrum antibiotics, antifungals, and multiple red blood cell transfusions (a total of 10 units) were initiated due to persistent anemia. A pcr test for covid-19 returned positive on day 19, prompting the initiation of treatment with low-dose dexamethasone (8 mg daily intravenously for ten days) and colchicine (1 mg orally every 12 h) due to pulmonary inflammation and the risk of fibrosis. After 5 months of follow-up amml relapse was confirmed.
Remission Characteristics
By day 39, her hemogram had returned to normal. A follow-up flow cytometry analysis of the bone marrow revealed less than 1 % of myeloid precursors and less than 5 % of monocytic line presence, with no immuno-phenotype for lama detected.
Treatment & Mechanisms
Proposed Remission Mechanisms
1. The coronavirus controls the adaptive viral response by inhibiting the ifn pathway through the blocking of tlr and rlr receptors and the downregulation of nuclear transcription factors. 2. Inflammatory macrophages in alveolar tissues induce chemotaxis, sequestration, and peripheral depression of leukemic monocytes, NK cells, and lymphocytes, changing them to an inflammatory cxcr3+ phenotype. 3. Elevated IL-2 levels in severe covid-19 may downregulate amml cells through an antitumor effect upon the activation of cytotoxic t and NK cells. 4. Cross-immunity induced by the coronavirus may control amml clones by stimulating g-csf production. 5. Transfusion of non-irradiated blood components may contribute to rs amml, potentially through a graft-versus-leukemia (gvl) effect. 6. Adjuvant treatment for covid-19 with colchicine, due to its anti-microtubule effect, may slow cell division in amml cells.
Clinical Treatment
Wisdom tooth removal broad-spectrum antibiotics, antifungals, 10 units of red blood cells. Dexamethasone 8mg daily for 10 days and colchicine 1 mg every 12h.
Non-Clinical Treatment
None reported