A Rare Case Of Spontaneous Remission Of Terminal Deoxynucleotidyl Transferase Negative B-acute Lymphoblastic Leukemia
Iqbal, A., Weinstein, J., Angelova, V., Dighe, D., & Giordano, L. (2018). A Rare Case of Spontaneous Remission of Terminal Deoxynucleotidyl Transferase Negative B-acute Lymphoblastic Leukemia. Journal of pediatric hematology/oncology, 40(3), e176–e178. https://doi.org/10.1097/MPH.0000000000000906
View Original Source →Abstract
Spontaneous remission of untreated pediatric leukemia is an extremely rare occurrence. The underlying mechanism may be because of an immune-mediated process or increased cortisol production during stress or infection. We describe a rare case of terminal deoxynucleotidyl transferase negative B-acute lymphoblastic leukemia with concurrent infection that went into remission without treatment with chemotherapy or corticosteroids. Though B-acute lymphoblastic leukemia can rarely go into spontaneous remission, these patients require close follow-up as most patients will eventually develop recurrence.
Case Details
Disease Location
Bone marrow
Personal Characteristics
15-month-old female
Clinical Characteristics
Presented with fevers, upper respiratory infection (uri) symptoms, and progressive skin infection. Laboratory showed anemia and pancytopenia. Bone marrow aspirates and biopsies were performed. It revealed approximately 20% blasts, and the left core biopsy showed 80% blasts. Flow cytometry of the abnormal population was consistent with b-acute lymphoblastic leukemia (b-all). Cytogenetic analysis showed an abnormal karyotype: 46, x, del (x) (q12). In addition, the patient had a necrotizing skin infection with multiple lesions including gluteal and anal ulcers extending to the rectum that grew pseudomonas aeruginosa, requiring treatment with antibiotics, debridement, and ultimately diverting colostomy. 173 days after the initial diagnosis, the disease recurred. The patient was treated with chemotherapy.
Remission Characteristics
Seven days after the initial biopsy, repeat bone marrow aspiration showed no evidence of leukemia. Her pancytopenia resolved after treatment of the infection.
Treatment & Mechanisms
Proposed Remission Mechanisms
Infection was the likely cause of transient remission in our patient as she presented with an extensive necrotizing pseudomonas aeruginosa skin infection.
Clinical Treatment
Bone marrow biopsy
Non-Clinical Treatment
None reported