Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2022; 10(22): 7890-7898
Published online Aug 6, 2022. doi: 10.12998/wjcc.v10.i22.7890
Antibiotic and glucocorticoid-induced recapitulated hematological remission in acute myeloid leukemia: A case report and review of literature
Xiao-Yun Sun, Xiao-Dong Yang, Xiao-Qiu Yang, Bo Ju, Nuan-Nuan Xiu, Jia Xu, Xi-Chen Zhao
Xiao-Yun Sun, Xiao-Dong Yang, Bo Ju, Nuan-Nuan Xiu, Jia Xu, Xi-Chen Zhao, Department of Hematology, The Central Hospital of Qingdao West Coast New Area, Qingdao 266555, Shandong Province, China
Xiao-Qiu Yang, Department of Pharmacology, The Central Hospital of Qingdao West Coast New Area, Qingdao 266555, Shandong Province, China
Author contributions: Sun XY, Yang XD and Yang XQ analyzed the data and drafted the manuscript; Sun XY, Yang XD, Ju B, Xiu NN, Xu J participated in the treatment of this patient; Zhao XC supervised the treatment and finally decided on the manuscript; and all authors have read and approved the final version of the manuscript.
Supported by the Specialized Scientific Research Fund Projects of The Medical Group of Qingdao University, No. YLJT20201002.
Informed consent statement: Written informed consent was not obtained from the patient.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xi-Chen Zhao, MD, Chief Doctor, Department of Hematology, The Central Hospital of Qingdao West Coast New Area, No. 9 Huangpujiang road, Qingdao 266555, Shandong Province, China. zhaoxichen2003@163.com
Received: August 10, 2021
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
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

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

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

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.