Repeated spontaneous remission of acute myeloid leukemia in response to various infections: a case report
Osamu Imataki1, Tomoya Ishida2, Jun-Ichiro Kida2
1Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-town, Kita-county, Kagawa, 761-0793, Japan. imataki.osamu@kagawa-u.ac.jp.
Background:
Acute myeloid leukemia (AML) is a progressive hematological malignancy that can be fatal when left untreated. However, spontaneous remission is rarely observed in the presence of infectious diseases.
Case Presentation:
We treated an 80-year-old woman with AML who spontaneously underwent remission after infections. Spontaneous remission was observed after each of three independent clinical infections caused by different pathogens-nontuberculous Mycobacterium infection, pulmonary aspergillosis, and Escherichia coli bacteremia. All infections were treated promptly with antimicrobials. Mycobacterium avium infection was treated with azithromycin, rifampin, and ethambutol. Pulmonary aspergillosis was treated with itraconazole followed by voriconazole. E. coli infection was treated with meropenem. During each infectious episode, leukemic cells disappeared from the patient's peripheral blood and pancytopenia improved without routine blood transfusion. These clinical effects lasted for several months. The patient has survived for > 2 years beyond the median survival time of end-stage AML. Thus, this case represents an immunological antileukemic effect of systemic infections.
Conclusions:
We have discussed a common mechanism of spontaneous remission of AML without chemotherapy, clinically exhibited by infection immunology. We believe that infections exert a limited immunological effect against AML, which may prolong survival among elderly individuals with AML.
Insights
Infections can trigger rare spontaneous remissions in acute myeloid leukemia (AML). This case study shows how treating infections in AML patients may offer a temporary immunological antileukemic effect, potentially prolonging survival.
Area of Science:
- Hematology
- Immunology
- Oncology
Background:
- Acute myeloid leukemia (AML) is a serious blood cancer. Spontaneous remission is uncommon, especially with infections.
- Elderly patients with AML often have a poor prognosis without chemotherapy.
Observation:
- An 80-year-old woman with AML experienced spontaneous remission following three separate infections.
- These infections included nontuberculous Mycobacterium, pulmonary aspergillosis, and Escherichia coli bacteremia.
- Leukemic cells decreased, and blood counts improved during each infection without standard treatments.
Findings:
- Prompt antimicrobial treatment of infections led to temporary remission of AML.
- The patient survived over two years beyond the expected median survival time for advanced AML.
- This suggests a potential immunological antileukemic effect mediated by systemic infections.
Implications:
- Infections may induce a limited immunological response against acute myeloid leukemia.
- This phenomenon could offer a survival benefit for elderly AML patients.
- Further research into infection-induced immunology could reveal novel therapeutic strategies for AML.
