Glucocorticoid and Antibiotic Treatment-induced Recapitulated Hematological Remissions in Acute Myeloid Leukemia: Implications for Ligand-dependent Growth and Survival Advantage

Abstract

Leukemia-transformed multipotential hematopoietic cells have acquired the increased self-renewal capacity and impaired myeloid differentiation to mature blood cells. The emergence of symptomatic leukemia also critically requires the acquisition of growth and survival advantage in leukemic cells. Untreated leukemia patients usually demonstrated a progressive process. However, spontaneous remission occasionally occurred in a very small number of leukemia patients, which frequently followed a febrile episode and antibiotic treatment and was generally attributed to the activation of anti-neoplastic activities. Here we report a 63-year-old Chinese man who presented with the main complaints of abdominal pain, febrile episode and urticaria-like skin lesions. He was diagnosed with acute myeloid leukemia (AML-M4) with t(8;21)(q22;q22)/RUNX1-RUNX1T1 on the basis of morphological, immunological, cytogenetic and molecular analysis. He also had a mutated FLT3-TKD gene. He was treated with antibiotics and glucocorticoid for the gastrointestinal infection and the urticaria-like skin lesions. The infection and skin lesions were quickly resolved. Unexpectedly, along with the relief of the febrile episode, abdominal symptoms and skin lesions, he achieved a hematological remission. After relapse, repeating this treatment resulted in the second hematological remission. These recapitulated treatment responses strongly suggested that inflammatory stresses arising from the gut inflammatory lesions, which could be largely mitigated by antibiotic and glucocorticoid treatment, sustained the growth and survival advantage of the leukemic cells.