Spontaneous hematological remission of acute myeloid leukemia

Abstract

Spontaneous remission (SR) of acute myeloid leukemia (AML) in adults is observed very rarely. To date, about 100 cases have been presented in the literature. To our best knowledge, we describe the first adult Polish patient suffering from acute myelomonocytic leukemia (48, XY, +13, +21/46, XY), in whom after supportive therapy, including non-irradiated, non-leukocyte depleted red cell transfusions and low-dose corticosteroid, we observed resolution of the disease without cytogenetic remission. We suggest a potential transfusion-associated graft versus-host-diseases (TA-GVHD) and graft-versus leukemia (GVL) reaction which might lead to spontaneous hematological remission. However, we did not observe clinical symptoms of such reactions apart from a short episode of non-infectious diarrhea. Additionally, steroids were administered but their role in inducing SR, in our opinion, seems less probable. This 77-year-old man remained in SR for 7 months, when repeated analysis showed AML recurrence. He died due to septic shock 2.5 months later. Additionally, we present a review of the literature.

Spontaneous Remission in a Patient With Acute Myeloid Leukemia Leading to Undetectable Minimal Residual Disease

“…In fact, in one study, up to 72% of patients who presented to the hospital at one institution with de novo AML had a concomitant fever at presentation [15]. In addition, there have been several case reports with patients who had an SR of their AML without a preceding infection, making it unlikely that infection alone could explain all cases of SR of AML [2][3][4][5][6][7].…”

“…It was first described in the literature by Eisenlohr in 1878 after a patient had regression of "marked leukocytosis" after a severe typhoid infection [1]. More recently, Rashidi and Fisher reviewed 46 cases of SR of AML from 1951 to 2014 and there have been several other case reports since 2014 describing this phenomenon [2][3][4][5][6][7].…”

Case Report: Spontaneous remission of early T-cell precursor acute lymphoblastic leukemia

“…Especially the association between transfusion of different blood components and SR was reported. 6 Indeed, a possible anti-leukemic effect could be observed especially in patients who have been treated with non-irradiated blood products. This effect may stimulate remission mediated by transfusion-associated graft-versus-host disease (TA-GVHD) and graft-versus-host leukemia (GVL) reaction.…”

“…1,2 SR has been reported in various hematological malignancies, for example: in adult T-cell lymphoma, 3 in chronic lymphocytic leukemia (CLL), 4 in myelodysplastic syndrome (MDS), 5 in acute myeloid leukemia (AML), rarely in acute lymphoblastic leukemia (ALL) in children and exceptionally in adults. 2,6,7 SRs are often related to infections or other immune stimulators, resulting in potent immune activation playing a crucial role in controlling the leukemic clone. 8,9 Nevertheless, the underlying mechanism of this phenomenon is not clearly described.…”

Inhibition of acute leukemia with attenuated Salmonella typhimurium strain VNP20009

“…Spontaneous complete remission (SCR) of leukemia denotes either partial or complete morphologic disappearance of leukemia without administration of anti-leukemic therapy. The earliest report of SCR in AML was published in 1878 and subsequent publications have reported about 100 cases of SCR in acute leukemia worldwide [20,21]. Most SCRs have been reported to be accompanied by severe microbial infection.…”