Published online Aug 6, 2022. doi: 10.12998/wjcc.v10.i22.7890
Peer-review started: August 10, 2021
First decision: October 20, 2021
Revised: October 29, 2021
Accepted: June 24, 2022
Article in press: June 24, 2022
Published online: August 6, 2022
Processing time: 345 Days and 19.7 Hours
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.
Core Tip: Untreated leukemia patients usually experience an aggressive process. However, spontaneous remission occasionally occurs in a small number of patients with acute myeloid leukemia. Here, we report an acute myeloid leukemia (AML) patient with t(8;21) translocation who achieved recapitulated spontaneous remissions after antibiotic and dexamethasone treatments for febrile episodes and skin lesions. These antibiotic and dexamethasone treatment-induced spontaneous remissions indicated that inflammatory stresses, most likely arising from gastrointestinal infection, sustained the growth and survival advantage of the leukemia cells. Inflammation-sustained proliferation may represent a specific subgroup of AML.