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Spontaneous Remission In A Patient With Chronic Myeloid Leukemia: A Case Report

Alshurafa, A. 2023Leukemia

Alshurafa, A., Ekeibed, Y., Akiki, S., Alzeyara, M., Nawaz, Z., & Yassin, M. A. (2023). Spontaneous Remission in a Patient with Chronic Myeloid Leukemia: A Case Report. Case reports in oncology, 16(1), 1073–1079. https://doi.org/10.1159/000533660

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Abstract

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm in which granulocytic cells are the main proliferative component. At diagnosis, more than 90% of CML cases have the characteristic Philadelphia chromosome, containing the BCR::ABL1 fusion gene. The natural history of untreated CML is an initial indolent chronic phase which will be followed by an accelerated phase, blast phase, or both. Tyrosine kinase inhibitors (TKIs) have dramatically altered the natural history of CML. TKI discontinuation with the goal of treatment-free remission is currently part of current management recommendations. However, spontaneous remission without receiving any treatment is extraordinarily rare in CML patients. Herein, we report a 56-year-old male who presented with leukocytosis and was diagnosed as a case of CML in the chronic phase; however, treatment with TKIs was not initiated due to spontaneous hematological as well as molecular remission.

Case Details

Disease Location

Blood

Personal Characteristics

56-year-old male, history of diabetes mellitus well controlled on metformin, ex-smoker

Clinical Characteristics

Referred to the hematology clinic for evaluation after the result of a routine complete blood count (cbc) which showed leukocytosis. Laboratory investigation showed mild anemia, leukocytosis, ldh was elevated. Peripheral smear revealed neutrophilic leukocytosis with the shift to the left and basophilia. Bone marrow aspirate and biopsy were consistent with chronic myeloid leukemia (cml) in the chronic phase. Fluorescence in situ hybridization analysis revealed bcr::abl1 rearrangement, t(9;22) in 86% of cells analyzed. Chromosomal analysis showed abnormal karyotype; 46,xy,t(9; 22)(q34;q11.2)[31]/46,xy[4]

Remission Characteristics

Two weeks after the initial laboratories, follow-up cbc showed wbcs dropped from 26.8 to 18, and 2 weeks after that, it dropped to 5.3 and basophilia has resolved; serial follow-up results. Molecular follow-up showed improvement of a bcr:: abl1 to abl1 percentage ratio of 3% and 0.06% at 3- and 5-month follow-up, respectively

Treatment & Mechanisms

Clinical Treatment

Bone marrow aspirate and biopsy

Non-Clinical Treatment

None reported