Spontaneous Remission Of Chronic Lymphocytic Leucemia In A Patient With Sars-cov2
Bülbül, H., Nazlı, H. E., Olgun, A., Togay, A., & Kahraman, D. S. (2022). Spontaneous remission of chronic lymphocytic leucemia in a patient with SARS-CoV2. Leukemia research reports, 18, 100336. https://doi.org/10.1016/j.lrr.2022.100336
View Original Source →Abstract
Although novel therapies have improved the treatment outcome of patients, chronic lymphocytic leukaemia (CLL) is still considered incurable. Recently, a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), causing coronavirus disease 2019 (Covid 19), emerged in late 2019, and it has posed a global health threat. In a limited number of cases, it has been shown that some lymphoma types spontaneously regress after SARS-CoV2 infection suggesting that the infection can trigger de immune system against the tumour cell. Cross-reactivity of pathogen-specific T cells with tumour antigens and natural killer cell activation can be the possible mechanism of this hypothesis.
Case Details
Disease Location
Blood
Personal Characteristics
67-year old male. History of asymptomatic untreated rai stage 1 cll for 8 years, hypertension and diabetes
Clinical Characteristics
Presented to the emergency department with a 2-day history of shortness of breath and fever. Physical examination revealed multiple lymphadenopathies, the largest of which was 20 × 10 mm, in bilateral neck and axillary regions. Rhonchi and fine crackles were heard in the middle and lower zones of the lungs. Laboratory investigations showed leukocytosis, neutropenia, lymphocytosis, mild anemia. In peripheral blood flow cytometry, proliferation of monotypic b lymphocytes, which constitute 89% of lymphocytes and display CD19+, cd 20+, CD22+, CD5+, CD23+, HLA dr+ immunophenotypes, was detected. Chest CT revealed that multiple enlarged lymphadenopathies, the largest of which was 30 × 17 mm in mediastinal, bilateral hilar, subcarinal regions and bilateral pleural effusion reaching approximately 10 mm in thickness and ground-glass opacities associated with bilateral and multilobar consolidation foci, predominantly peripheral, some with a rounded aspect. Diagnosis of covid 19 was confirmed via polymerase chain reaction (pcr) of a nasopharyngeal (np) swab. On the 7th day of admission, the patient developed pancytopenia and high fever treated with favipiravir for ten days. Due to etiology of fever is unknown, multiple treatments, including intravenous immunoglobulin and broad-spectrum antibiotics were used for febrile neutropenia.
Remission Characteristics
Five months after admission, it was observed that the cytopenias of the patient improved. To evaluate disease status, bone marrow aspiration biopsy, positron emission tomography (PET-CT) and flow cytometry were performed. Bone marrow biopsy was normocellular and infiltration was not distinguished. On PET CT, normal uptake of fluoro-2-deoxy-d-glucose (fdg) occurs in the whole body and no characteristic hypermetabolic focus that could be compatible with malignancy was detected.
Treatment & Mechanisms
Proposed Remission Mechanisms
The anti-tumour effects of proinflammatory cytokines may explain the spontaneous remission
Clinical Treatment
Favipiravir, bone marrow aspiration.
Non-Clinical Treatment
None reported