Maywald O, Buchheidt D, Bergmann J, Schoch C, Ludwig W-D, Reiter A, Hastka J, Lengfelder E, Hehlmann R
III. Medizinische Universitätsklinik, Fakultät für Klinische Medizin Mannheim der Universität Heidelberg, Wiesbadener Strasse 7-11, 68305, Mannheim, Germany.
Ann Hematol. 2004 Mar;83(3):189-94. doi: 10.1007/s00277-003-0741-y. Epub 2003 Oct 3.
Spontaneous remission of acute myeloid leukemia in the adult is a rare event. We report on a 31-year-old male patient suffering from acute myeloid leukemia (AML) M5a according to the French-American-British (FAB) classification with biphenotypic features in flow cytometric examination and severe bacterial infection with group G streptococci at the time of diagnosis. Because of sepsis and stable clinical conditions, chemotherapy was delayed and antibiotics were administered intravenously. Within 6 weeks a spontaneous remission of AML occurred. Remission lasted for about 2 months. At the time of relapse, a change in phenotype of the leukemic blasts with a loss of B-lymphoid markers could be demonstrated by flow cytometry. The patient was treated with an induction therapy according to the multicentric German AMLCG 2000 schedule. To our knowledge, this is the first report of a spontaneous remission in an AML FAB M5a associated with coexpression of myeloid- and lymphoid-associated antigens on the leukemic blasts. Possible mechanisms of this phenomenon are discussed with a review of the literature.
成人急性髓系白血病的自发缓解是罕见事件。我们报告一例31岁男性患者，根据法美英（FAB）分类为急性髓系白血病（AML）M5a，流式细胞术检查显示具有双表型特征，诊断时伴有G组链球菌严重细菌感染。由于脓毒症且临床状况稳定，化疗延迟并静脉给予抗生素。6周内AML出现自发缓解。缓解持续约2个月。复发时，流式细胞术可显示白血病原始细胞表型改变，B淋巴细胞标志物丢失。该患者按照多中心德国AMLCG 2000方案接受诱导治疗。据我们所知，这是首例FAB M5a型AML自发缓解且白血病原始细胞同时表达髓系和淋巴系相关抗原的报告。结合文献综述讨论了这一现象可能的机制。
