• Pregnancy
• Female
• Humans
• Ecosystem
• Neoplasms/metabolism
• Myeloproliferative Disorders/pathology
• Hematopoietic Stem Cells/metabolism
• Inflammation/metabolism
• Cytokines/metabolism

• R01 CA268496 NCI NIH HHS
• R01 CA257602 NCI NIH HHS
• R01 CA254354 NCI NIH HHS

• Chronic myeloid leukemia
• Philadelphia chromosome
• Spontaneous remission
• Tyrosine kinase inhibitors

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.

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.

Inflammatory stresses, most likely arising from gastrointestinal infection, may sustain the growth and survival advantage of leukemic cells.

• Acute myeloid leukemia
• Fms-like tyrosine kinase 3 tyrosine kinase domain
• Glucocorticoid
• Antibiotic
• Spontaneous remission
• Gastrointestinal infection
• Case report

• Infection
• Leukemia
• MLL-AF9 rearrangement
• Spontaneous remission

• Adult
• Aged
• Aged, 80 and over
• Female
• Gene Rearrangement
• Humans
• Leukemia, Myeloid, Acute/genetics
• Liver Diseases
• Male
• Middle Aged
• Myeloid-Lymphoid Leukemia Protein/genetics
• Oncogene Proteins, Fusion/genetics
• Remission, Spontaneous
• Retrospective Studies

•

Spontaneous remission (SR) of cancer is a rare but well-documented phenomenon.

Many diseases heal spontaneously. The common cold, for example, remedies itself within a few days in people with an uncompromised immune system. If a disease with a poor prognosis heals in the absence of a targeted therapeutic, many even call it a miracle cure. Such is the case with the spontaneous regression (SR) of malignant neoplasms, a rare but well-documented phenomenon that finds its first mention in the Ebers Papyrus of 1550 BCE. Given the challenges associated with current cancer treatment modalities such as rapidly evolving drug resistance mechanisms, dose-limiting side effects, and a failure to completely eliminate cancer cells, knowledge of how a tumour heals itself would be immensely helpful in developing more effective therapeutic modalities. Although the intricate mechanisms of SR have yet to be fully elucidated, it has been shown that infection-mediated immune system activation, biopsy procedures, and disruptions of the tumour microenvironment play pivotal roles in the self-healing of many tumours. Bacterial and viral infections are especially well-documented in instances of SR. Insights from these findings are paving the way for novel therapeutic strategies. Inspired by bacteria-mediated SR, Bacillus Calmette-Guérin (BCG) has been used as an approved treatment option for non-muscle-invasive bladder cancer (NMIBC). Similarly, Talimogene laherparepvec (T-VEC), the first engineered oncolytic herpes simplex virus (HSV), has been approved by the United States Food and Drug Administration for the treatment of some forms of advanced melanoma. Here we describe the current understanding of SR, explore its therapeutic significance, and offer perspectives on its future.

• BCG
• Oncolytic virus
• Spontaneous regression
• T-VEC
• Tumour immunology

• ALL R3
• Down syndrome
• Relapsed acute lymphoblastic leukemia
• remission

• K12 CA076917 NCI NIH HHS