Spontaneous Remission of Acute Myeloid Leukemia With Mutated NPM1 Following SARS-CoV-2 Infection

Acute myeloid leukemia (AML) with NPM1 mutation is the most common of the genetically defined AMLs in adults. Spontaneous remission (SR) of AML is very rare but well documented in the literature with < 40 reported cases in the last 25 years. SR of AML is usually short in duration, and most patients relapse in < 6 months. Causes of SR of AML are unclear, but most cases occurred in association with infection, including a few recently reported cases associated with SARS-CoV-2 infection. We report a unique case of a 77-year-old female with a 4-year history of cytopenias prior to diagnosis of AML with mutated NPM1, concurrent with an infection by SARS-CoV-2. She subsequently experienced a SR of AML with loss of the NPM1 mutation. After entering SR, the patient was initiated on treatment with subcutaneous azacitidine and venetoclax and has remained in remission for 44 months. Clinicians should be aware of this rare phenomenon and closely follow up these patients, as the SR of AML is usually of short duration.