Spontaneous Remission In A Patient With Very Late Relapse Of Acute Myeloid Leukemia 17 Years After Allogeneic Blood Stem Cell Transplantation
Rautenberg, C., Kaivers, J., Germing, U., Haas, R., Schroeder, T., & Kobbe, G. (2019). Spontaneous remission in a patient with very late relapse of acute myeloid leukemia 17 years after allogeneic blood stem cell transplantation. European journal of haematology, 103(2), 131–133. https://doi.org/10.1111/ejh.13245
View Original Source →Abstract
Spontaneous remission (SR) of acute myeloid leukemia (AML) represents a rare phenomenon and is usually of short duration although long-term remissions are reported. Indeed, mechanisms underlying SR remain unclear, but it is suggested that immunactivation, e.g. caused by infections, plays an important role. Here we report on a patient who suffered from pneumonia and simultaneously experienced very late hematologic AML relapse seventeen years after allogeneic blood stem cell transplantation (allo-BSCT). Surprisingly in parallel to recovery from pneumonia peripheral blood count which previously showed pancytopenia, had normalized and bone marrow (BM) aspiration revealed spontaneous remission of AML. To the best of our knowledge we here report on the latest AML relapse after allo-BSCT experiencing SR.
Case Details
Disease Location
Bone marrow
Personal Characteristics
42‐year‐old woman, diagnosed with aml fab m0 with a cytogenetic aberration (der(4)t(4;12)(p12;q12)), allogeneic blood stem cell transplantation (allo‐bsct) was performed with complete response.
Clinical Characteristics
Seventeen years after allo‐bsct, she suffered from hand-foot-and-mouth disease (hfmd). Laboratory findings showed increased levels of c‐reactive protein, procalcitonin, and lactate dehydrogenase. In addition, anemia and pancytopenia were found. CT of the chest revealed pneumonia, and antibiotics were started. Cytomorphological, flow cytometric, and histological bone marrow (bm) analyses revealed a diagnosis of acute myeloid leukemia (aml) with a blast population comprising between 25%. Bm cytogenetics showed an additionally pre‐ sent marker chromosome (47,xx,+mar).
Remission Characteristics
Four weeks later concomitant to recovery from pneumonia, pb count had improved spontaneously to normal values and another bm aspiration showed spontaneous partial re‐ mission with 13% leukemic blasts.
Treatment & Mechanisms
Proposed Remission Mechanisms
The infection might have caused a powerful immunological activation counteracting both the infection and simultaneously stimulating augment graft‐vs‐leukemia (gvl) effects that could overcome hematological relapse and restore remission
Clinical Treatment
Allogeneic blood stem cell transplantation. Antibiotics. Bone marrow aspiration
Non-Clinical Treatment
None reported