Spontaneous Remission Of Acute Myeloid Leukemia: A Case Report
Martínez-Díez, Y., Franganillo-Suárez, A., Salgado-Sánchez, R., Atance-Pasarisas, M., Blas, C., Cotti-Ferrari, M. J., Castaño-Bonilla, T., Lainez-González, D., Rodríguez-Pinilla, S. M., Llamas-Sillero, P., & Alonso-Dominguez, J. M. (2022). Spontaneous Remission of Acute Myeloid Leukemia: A Case Report. Medicina (Kaunas, Lithuania), 58(7), 921. https://doi.org/10.3390/medicina58070921
View Original Source →Abstract
Spontaneous remissions (SRs) in acute myeloid leukemia (AML) are infrequent, poorly documented and transient. Similarly, morphological and cytogenetic complete remissions (CR) under azacitidine treatment are scarce. We report a 71-year-old man with a secondary AML arising from essential thrombocythemia (ET), who developed an SR after discontinuation of azacitidine following a respiratory infection (four courses were administered). The distinctive feature of our case is the depth of the achieved CR, documented by next-generation sequencing (NGS) techniques. We also detected persistence of molecular lesions that might already have been present in the previous ET clone. Our patient relapsed 5 months after achieving CR. We conclude that our patient showed a spontaneous remission of his AML rather than an exquisite response to azacitidine. We hypothesize that the concurrent respiratory infection, or any other unknown trigger, might have activated his immune system forcing the leukemic stem cell to enter a quiescent state through a yet unexplained mechanism.
Case Details
Disease Location
Blood
Personal Characteristics
71-year-old man, history of essential thrombocythemia (et) with jak2(v617f) at age 61 and treated with hydroxycarbamid
Clinical Characteristics
Presented complaining of constitutional syndrome. Complete blood count (cbc) showed leukocytosis with 27% of blasts, anemia, and thrombocytopenia. Bone marrow biopsy was performed, showing massive blast infiltration, consistent with the diagnosis of acute myeloid leukemia (aml) secondary to myeloproliferative neoplasms (mpn). The patient started hypomethylating therapy (azacitidine 75 mg/m2). After the 3rd cycle, he was admitted to the hospital with an upper respiratory infection, requiring intravenous antibiotics for 5 days. Azacitidine was discontinued after the 4th cycle due to high transfusional requirements (18 red cell concentrates and 2 platelet pools)
Remission Characteristics
Since drug discontinuation, the patient’s cbc progressively improved. Bone marrow examination showed <5% of blasts and negative minimal residual disease
Treatment & Mechanisms
Proposed Remission Mechanisms
Stimulators of the immune system, such as infections. Pneumonia in this case
Clinical Treatment
Bone marrow biopsy, azacitidine, IV antibiotics
Non-Clinical Treatment
None reported