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Sun XY, Yang XD, Yang XQ, Ju B, Xiu NN, Xu J, Zhao XC. Antibiotic and glucocorticoid-induced recapitulated hematological remission in acute myeloid leukemia: A case report and review of literature. World J Clin Cases 2022; 10:7890-7898. [PMID: 36158489 PMCID: PMC9372864 DOI: 10.12998/wjcc.v10.i22.7890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/29/2021] [Accepted: 06/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Leukemic hematopoietic cells acquire enhanced self-renewal capacity and impaired differentiation. The emergence of symptomatic leukemia also requires the acquisition of a clonal proliferative advantage. Untreated leukemia patients usually experience an aggressive process. However, spontaneous remission occasionally occurs in patients with acute myeloid leukemia (AML), most frequently after recovery from a febrile episode, and this is generally attributed to the triggering of antineoplastic immunity. There may be another explanation for the spontaneous remission as implicated in this paper.
CASE SUMMARY A 63-year-old Chinese man presented with high fever, abdominal pain and urticaria-like skin lesions. He was diagnosed with AML-M4 with t(8;21) (q22;q22)/RUNX1-RUNX1T1 based on morphological, immunological, cytogenetic and molecular analyses. He had a complex chromosome rea-rrangement of 48,XY,t(8;21)(q22;q22),+13,+13[9]/49,idem,+mar[9]/49,idem,+8[2]. He also had a mutated tyrosine kinase domain in fms-like tyrosine kinase 3 gene. He was treated with antibiotics and glucocorticoids for gastrointestinal infection and urticaria-like skin lesions. The infection and skin lesions were quickly resolved. Unexpectedly, he achieved hematological remission along with resolution of the febrile episode, gastrointestinal symptoms and skin lesions. Notably, after relapse, repeating these treatments resulted in a return to hematological remission. Unfortunately, he demonstrated strong resistance to antibiotic and glucocorticoid treatment after the second relapse and died of sepsis from bacterial infection with multidrug resistance. The main clinical feature of this patient was that symptomatic AML emerged with flaring of the gut inflammatory disorder and it subsided after resolution of the inflammation. Learning from the present case raises the possibility that in a subgroup of AML patients, the proliferative advantage of leukemia cells may critically require the presence of inflammatory stresses.
CONCLUSION Inflammatory stresses, most likely arising from gastrointestinal infection, may sustain the growth and survival advantage of leukemic cells.
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Affiliation(s)
- Xiao-Yun Sun
- Department of Hematology, The Central Hospital of Qingdao West Coast New Area, Qingdao 266555, Shandong Province, China
| | - Xiao-Dong Yang
- Department of Hematology, The Central Hospital of Qingdao West Coast New Area, Qingdao 266555, Shandong Province, China
| | - Xiao-Qiu Yang
- Department of Pharmacology, The Central Hospital of Qingdao West Coast New Area, Qingdao 266555, Shandong Province, China
| | - Bo Ju
- Department of Hematology, The Central Hospital of Qingdao West Coast New Area, Qingdao 266555, Shandong Province, China
| | - Nuan-Nuan Xiu
- Department of Hematology, The Central Hospital of Qingdao West Coast New Area, Qingdao 266555, Shandong Province, China
| | - Jia Xu
- Department of Hematology, The Central Hospital of Qingdao West Coast New Area, Qingdao 266555, Shandong Province, China
| | - Xi-Chen Zhao
- Department of Hematology, The Central Hospital of Qingdao West Coast New Area, Qingdao 266555, Shandong Province, China
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Felix CA, Slater DJ, Davenport JW, Yu X, Gregory BD, Li MM, Rappaport EF, Cheung NKV. KMT2A-MAML2 rearrangement emerged and regressed during neuroblastoma therapy without leukemia after 12.8-year follow-up. Pediatr Blood Cancer 2022; 69:e29344. [PMID: 34550633 PMCID: PMC9616630 DOI: 10.1002/pbc.29344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/09/2021] [Accepted: 08/19/2021] [Indexed: 01/03/2023]
Abstract
Twelvepatients without therapy-related leukemia were studied after completing TOP2 poison chemotherapy in a high-risk neuroblastoma regimen. One patient harbored an inv(11) that was a KMT2A rearrangement. The KMT2A-MAML2 transcript was expressed at low level. The patient was prospectively followed. The inv(11) was undetectable in ensuing samples. Leukemia never developed after a 12.8-year follow-up period. Enriched etoposide-induced TOP2A cleavage in the relevant MAML2 genomic region supports a TOP2A DNA damage mechanism. After completing TOP2 poison chemotherapies, covert KMT2A-R clones may occur in a small minority of patients; however, not all KMT2A rearrangements herald a therapy-related leukemia diagnosis.
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Affiliation(s)
- Carolyn A. Felix
- Division of Oncology, The Children’s Hospital of Philadelphia, Center for Childhood Cancer Research, Philadelphia, PA 19104,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104,Corresponding Author: Carolyn A. Felix, M.D., Professor of Pediatrics, Joshua Kahan Endowed Chair in Pediatric Leukemia Research, Division of Oncology, The Children’s Hospital of Philadelphia, Colket Translational Research Building, Room 4006, 3501 Civic Center Blvd., Philadelphia, PA 19104-4318, (215) 590-2831,
| | - Diana J. Slater
- Division of Oncology, The Children’s Hospital of Philadelphia, Center for Childhood Cancer Research, Philadelphia, PA 19104,Nucleic Acids and PCR Core Facility, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104
| | - James W. Davenport
- Division of Oncology, The Children’s Hospital of Philadelphia, Center for Childhood Cancer Research, Philadelphia, PA 19104
| | - Xiang Yu
- Biology Department, University of Pennsylvania, Philadelphia, PA 19104
| | - Brian D. Gregory
- Biology Department, University of Pennsylvania, Philadelphia, PA 19104
| | - Marilyn M. Li
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104,Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104,Division of Genomic Diagnostics, Children’s Hospital of Philadelphia, Philadelphia, PA, 19104,Department of Pathology and Laboratory Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, 19104
| | - Eric F. Rappaport
- Nucleic Acids and PCR Core Facility, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104
| | - Nai-Kong V. Cheung
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021
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Fan WJ, Xu TT, Sang LN, Guo JJ, Li YF, Pei ZX, Jiang ZX. [A case of spontaneous remission of acute myeloid leukemia with MLL-AF9 rearrangement and abnormal liver function]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2021; 42:851-857. [PMID: 34788926 PMCID: PMC8607016 DOI: 10.3760/cma.j.issn.0253-2727.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Indexed: 11/13/2022]
Abstract
Objective: To explore the clinical features and possible pathogenesis of spontaneous remission of acute myeloid leukemia (AML) . Methods: We retrospectively analyzed the clinical data of a patient with spontaneous remission of AML, MLL-AF9 rearrangement, and abnormal liver function in the First Affiliated Hospital of Zhengzhou University, and the relevant pieces of literature were summarized. Results: The patient experienced lung infection, fever, and liver dysfunction and was treated with anti-infection and blood transfusion. After complete response (CR) , the patient remained in CR with mild, indirect bilirubin elevation at 35 months of follow-up. Additionally, 56 cases of adult AML (non-acute promyelocytic leukemia) were reported in the literature from 1990 to June 2021. The cases were checked by bone marrow aspiration, and our patients were summarized and analyzed. Furthermore, 57 patients, including 37 males and 20 females, with a median age of 51 (20-83) years and a median remission time of five months; 52 patients achieved complete remission. In addition, there were five cases with long-term remission and a chromosomal record, with no recurrence so far, three with normal karyotype and two with t (9;11) (q21;q23) . Conclusion: The spontaneous remission of leukemia is rare and may be related to immunosuppression and genes.
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Affiliation(s)
- W J Fan
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - T T Xu
- Department of Blood Transfusion, Henan Provincial People's Hospital, Zhengzhou 450000, China
| | - L N Sang
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - J J Guo
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Y F Li
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Z X Pei
- Jiaozuo First People's Hospital, Jiaozuo 454002, China
| | - Z X Jiang
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
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Abstract
Spontaneous remission (SR) of acute myeloid leukemia (AML) is rare. We collected all 46 reported cases of AML with SR. Fever occurred in 91.3% of cases before remission, which was largely due to pneumonia (54.5%) and bacteremia (24.2%). Pneumonia and bacteremia were significantly more common among those who achieved complete remission (CR) compared to those who achieved only a partial remission (p = 0.032). Although 88.6% of remissions were CR, the median duration of remission was only 5 months. Eight cases did not relapse during the follow-up period. The mechanism of SR in AML likely involves the stimulatory effect of systemic febrile infection on the immune system. Immediate treatment of infections and fever may contribute to the rarity of SR in AML. The results of this review improve our understanding of the important role of the immune system in countermanding AML and may provide new ideas for immunotherapy.
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Affiliation(s)
- Armin Rashidi
- Division of Oncology, Washington University School of Medicine , St. Louis, MO , USA
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Yang JJ, Park TS, Lee ST, Seo JY, Oh SH, Cho EH, Strehl S, Mühlegger N, Dworzak MN, Zuna J, Pospisilova D, Meyer C, Marschalek R, Kim HJ, Kim SH. Molecular characterization and clinical impact of t(11;15)(q23;q14-15) MLL-CASC5 rearrangement. Haematologica 2014; 99:e11-3. [PMID: 24425691 DOI: 10.3324/haematol.2013.095638] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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