Abstract
Spontaneous remission of B-lymphoblastic leukemia (B-ALL) in the setting of viral and bacterial infections has been reported. Here, we present a case of B-ALL that showed a complete remission in the setting of group A streptococcal bacteremia. The patient was an 11-year-old boy who presented with a sore throat, right ear pain, and rhinorrhea. Prior to the diagnosis of B-ALL, he was diagnosed with streptococcal pharyngitis and received a single dose of dexamethasone and azithromycin. One day later, he was found to be pancytopenic and an immunophenotypically abnormal B-lymphoblastic population was detected comprising 0.6% and 16.8% of the peripheral blood and bone marrow cells, respectively. Though a diagnosis of B-ALL was highly suspected, blast percentage was <20% and the bone marrow showed relatively unremarkable trilineage hematopoiesis. On close monitoring, the suspected neoplastic population became undetectable by day 17 and the patient’s complete blood count (CBC) completely normalized by day 46. On day 82, a peripheral blood smear demonstrated circulating blasts. Flow cytometry of a bone marrow aspirate revealed B-lymphoblastic leukemia accounting for 94% nucleated cells, consistent with the diagnosis of B-lymphoblastic leukemia. This case is of interest as less than 20 examples of spontaneous remission of B-ALL have been reported in the literature. As the case reported here relapsed and previously reported spontaneously remitting cases have uniformly relapsed, cases of B-ALL with spontaneous remission should be followed very closely for recurrence.
Similar content being viewed by others
References
Stiller CA (2004) Epidemiology and genetics of childhood cancer. Oncogene 23(38):6429–6444. https://doi.org/10.1038/sj.onc.1207717
Inaba H, Pui CH (2010) Glucocorticoid use in acute lymphoblastic leukaemia. Lancet Oncol 11(11):1096–1106. https://doi.org/10.1016/S1470-2045(10)70114-5
Kirtek T, Hamdan H, Van Arnam JS, Park S, Kovach AE, Pillai V, Weinberg OK (2023) Spontaneous remission of acute lymphoblastic leukemia: a series of nine cases and a review of literature. IntJ Lab Hematol 45(4):489–495
Frei E 3rd, Karon M, Levin RH, Freireich EJ, Taylor RJ, Hananian J, Selawry O, Holland JF, Hoogstraten B, Wolman IJ, Abir E, Sawitsky A, Lee S, Mills SD, Burgert EO Jr, Spurr CL, Patterson RB, Ebaugh FG, James GW 3rd, Moon JH (1965) The effectiveness of combinations of antileukemic agents in inducing and maintaining remission in children with acute leukemia. Blood 26(5):642–656
Gatineau-Sailliant S, Buchbinder N, Callat MP et al (2013) Steroid intake before leukemia diagnosis impairs outcome in childhood acute lymphoblastic leukemia. Arch Pediatr Organe Officiel de la Soc Francaise de Pediatrie 20(4):341–347. https://doi.org/10.1016/j.arcped.2013.01.016
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
None.
Conflict of interest
None.
Ethical approval
Not applicable.
Informed consent
Not applicable.
Consent for publication
Not applicable.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Gilbert, A., Tan, J., Nadimpalli, S. et al. B-lymphoblastic leukemia with transient spontaneous remission in the setting of severe group A streptococcus infection. J Hematopathol 16, 223–226 (2023). https://doi.org/10.1007/s12308-023-00564-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12308-023-00564-5