Repeated Spontaneous Remission Of Acute Myeloid Leukemia In Response To Various Infections: A Case Report
Imataki, O., Ishida, T., Kida, J. I., Uemura, M., Fujita, H., & Kadowaki, N. (2023). Repeated spontaneous remission of acute myeloid leukemia in response to various infections: a case report. BMC infectious diseases, 23(1), 215. https://doi.org/10.1186/s12879-023-08108-z
View Original Source →Abstract
BACKGROUND: Acute myeloid leukemia (AML) is a progressive hematological malignancy that can be fatal when left untreated. However, spontaneous remission is rarely observed in the presence of infectious diseases. CASE PRESENTATION: We treated an 80-year-old woman with AML who spontaneously underwent remission after infections. Spontaneous remission was observed after each of three independent clinical infections caused by different pathogens-nontuberculous Mycobacterium infection, pulmonary aspergillosis, and Escherichia coli bacteremia. All infections were treated promptly with antimicrobials. Mycobacterium avium infection was treated with azithromycin, rifampin, and ethambutol. Pulmonary aspergillosis was treated with itraconazole followed by voriconazole. E. coli infection was treated with meropenem. During each infectious episode, leukemic cells disappeared from the patient's peripheral blood and pancytopenia improved without routine blood transfusion. These clinical effects lasted for several months. The patient has survived for > 2 years beyond the median survival time of end-stage AML. Thus, this case represents an immunological antileukemic effect of systemic infections. CONCLUSIONS: We have discussed a common mechanism of spontaneous remission of AML without chemotherapy, clinically exhibited by infection immunology. We believe that infections exert a limited immunological effect against AML, which may prolong survival among elderly individuals with AML.
Case Details
Disease Location
Blood
Personal Characteristics
80-year-old japanese woman, history of bipolar disorder diagnosed at age 78. Smoker from the age of 20 to 50 years.
Clinical Characteristics
Diagnosed with aml with myelodysplasia-related changes (aml/mrc) via bone marrow examination. She was referred with the complication of gradually developing leukocytopenia and thrombocytopenia. The level of wt1 mrna, a biomarker, increased to 22,000 (normal range<50) copies/ml. Bone marrow cell count clonally increased to 4.01×104/μl; megakaryocyte count decreased to 18/ μl, and blast count increased to 45.4%. She was treated with blood transfusion therapy. During therapy her condition was complicated by the following three infectious diseases between 15 months: nontuberculous mycobacterium (ntm) infection, she received triple anti-mycobacterium (azithromycin, rifampin, and ethambutol) treatment for 2 weeks; pulmonary aspergillosis treated with levofloxacin for a few weeks, and escherichia coli bacteremia treated with with absces puncture drainage and continued antibiotic treatment.
Remission Characteristics
During each infection, remission was achieved. The case progression clinically proved infection-related spontaneous remission of aml in response to infection by three different pathogen types: mycobacterium avium (mycobacterium), aspergillus (fungus), and e. Coli (bacteria).
Treatment & Mechanisms
Proposed Remission Mechanisms
Systemic infections caused by three different pathogens exerted an antileukemic effect. These antitumor effects may be caused by cell-mediated immunity, cytokines, and growth factors
Clinical Treatment
Bone marrow aspiration, azitrhomycin, rifampin, ethambutol, levofloxacin
Non-Clinical Treatment
None reported