Spontaneous remission of acute myeloid leukemia relapse after hematopoietic cell transplantation in a high-risk patient with 11q23/MLL abnormality.
A 35-year-old female patient was diagnosed with acute myeloid leukemia with multiple genetic aberrations [48 XX, del(3)(q21), +6, t(11;15)(q23;q15), +21] including an 11q23/MLL abnormality. The patient achieved a complete remission after one induction chemotherapy cycle. After three courses of consolidation, a matched unrelated hematopoietic cell transplantation (HCT) was performed. Following an upper respiratory tract infection 7 years after transplant, her blood counts declined to leukocytes of 1 x 10(9)/l, platelets of 51 x 10(9)/l and hemoglobin of 7.5 g/dl. A bone marrow aspirate revealed 55% leukemic blasts carrying the unfavorable genetic aberrations seen at initial diagnosis (11q23/MLL). In the absence of any disease-specific treatment, the leukemic blasts cleared from the bone marrow within 6 days after diagnosis of relapse and peripheral blood counts returned to normal. Molecular analysis of the 11q23/MLL rearrangement was used to evaluate minimal residual disease, which became undetectable in repetitive FISH analyses. This is the first report of spontaneous remission in a patient with initially a multiaberrant leukemic cell clone and a proven 11q23/MLL abnormality at relapse after HCT.
Hudecek
Michael
M
Department of Hematology, Oncology and Coagulation, University of Leipzig, Leipzig, Germany. m.hudecek@gmx.de
Bartsch
Kristina
K
Jäkel
Nadja
N
Heyn
Simone
S
Pfannes
Roald
R
Al-Ali
Haifa Kathrin
HK
Cross
Michael
M
Pönisch
Wolfram
W
Gerecke
Ulrich
U
Edelmann
Jeanett
J
Ittel
Thomas
T
Niederwieser
Dietger
D
D000328:Adult; D001856:Bone Marrow Examination; D002869:Chromosome Aberrations; D002880:Chromosomes, Human, Pair 11; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D011495:Histone-Lysine N-Methyltransferase; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D015470:Leukemia, Myeloid, Acute / Q000473:pathology* / Q000628:therapy; D051788:Myeloid-Lymphoid Leukemia Protein / Q000235:genetics*; D012008:Recurrence; D012075:Remission, Spontaneous
C497422:KMT2A protein, human; D051788:Myeloid-Lymphoid Leukemia Protein; D011495:Histone-Lysine N-Methyltransferase