Spontaneous Remission Of Acute Lymphoblastic Leukemia: A Case Report
Höres, T., Wendelin, K., & Schaefer-Eckart, K. (2018). Spontaneous remission of acute lymphoblastic leukemia: A case report. Oncology letters, 15(1), 115–120. https://doi.org/10.3892/ol.2017.7288
View Original Source →Abstract
Spontaneous remission (SR) in acute lymphoblastic leukemia (ALL) is a rare phenomenon, but the disease course and its underlying processes are of basic and clinical interest. Herein is reported the case of a pregnant, 31-year-old patient who developed ALL, followed by septic shock and SR of ALL. Information is summarized from earlier case reports and incidences of SR in ALL, to identify common patterns. Furthermore, the phenomenon of SR is compared with another disease variant of ALL, termed prodromal or preceding-ALL (pre-ALL). SR and the aleukemic phase in pre-ALL are associated with fever and/or sepsis and have similar kinetics and epidemiology. Therefore, pre-ALL not only closely resembles SR in ALL, but both conditions may represent a single disease entity. Production of pro-inflammatory cytokines and immune cell effects may induce temporary remission of ALL and the suppression of hematopoiesis. In contrast to SR in other types of cancer, all documented cases of SR in ALL were only transient. However, the disease can still be effectively treated with standard ALL therapies following relapse.
Case Details
Disease Location
Blood
Personal Characteristics
A pregnant (gravida i, 30 weeks of gestation) 31-year-old female
Clinical Characteristics
Admitted with severe anemia, progressive fatigue, and excessive sweating. Laboratory showed lymphocytosis and severe neutropenia. Four units of erythrocyte concentrates were transfused. Two days later, enlarged cervical lymph nodes were noted, and the complete blood count (cbc) indicated progressive leukocytosis. Flow cytometry demonstrated mainly CD45 low leukocytes that expressed CD10, CD19, HLA-dr, CD20, cytoplasmic cd79a, and terminal deoxynucleotidyl transferase. Based on the flow cytometry findings, a diagnosis of common‐acute lymphoblastic leukemia (all) was determined. 16 day following initial presentation, the patient was admitted with preterm uterine contractions, rupture of the membranes, fever, pancytopenia, and elevated inflammation markers. She delivered a preterm, otherwise healthy infant. 6 weeks after remission, the disease relapsed. She was treated with chemotherapy.
Remission Characteristics
Over the next 8 days, the leucocyte count spontaneously dropped to 13/nl; the thrombocyte count and hb also decreased without treatment. 2 weeks after delivery, no atypical lymphocytes were detectable on microscopic blood film examination, and flow cytometry demonstrated a decreased amount of CD45 low leukocytes. Fish was negative for acsl-6 deletion in 100 analyzed interphase chromosomes. After 2 more weeks, flow cytometry of peripheral blood samples was negative for all.
Treatment & Mechanisms
Proposed Remission Mechanisms
Pro-inflammatory cytokines and immune cell activity during severe infection shift the balance of pro-leukemia towards an anti-leukemia environment, and induce temporary remission of all and a suppression of hematopoiesis.
Clinical Treatment
Erythrocyte transfusion
Non-Clinical Treatment
None reported