Spontaneous Remission of Blastic Plasmacytoid Dendritic Cell Neoplasm: A Case Report

被引:0
作者
Castano-Bonilla, Tamara [1 ,2 ]
Mata, Raquel [1 ,2 ]
Lainez-Gonzalez, Daniel [2 ]
Gonzalo, Raquel [1 ]
Castanon, Susana [1 ]
Diaz de la Pinta, Francisco Javier [3 ]
Blas, Carlos [1 ,2 ]
Lopez-Lorenzo, Jose L. [1 ,2 ]
Alonso-Dominguez, Juan Manuel [1 ,2 ]
机构
[1] Hosp Univ Fdn Jimenez Diaz, Hematol Dept, Madrid 28040, Spain
[2] Hosp Univ Fdn Jimenez Diaz, Inst Invest Sanitaria IIS FJD, Madrid 28040, Spain
[3] Hosp Univ Fdn Jimenez Diaz, Pathologycal Anat Dept, Madrid 28040, Spain
来源
MEDICINA-LITHUANIA | 2024年 / 60卷 / 05期
关键词
blastic plasmacytoid dendritic cell neoplasm; spontaneous remission; acute myeloid leukaemia; HEALTH-ORGANIZATION CLASSIFICATION; SPONTANEOUS REGRESSION; TAGRAXOFUSP; CANCER;
D O I
10.3390/medicina60050807
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Spontaneous remissions (SRs) in blastic plasmacytoid dendritic cell neoplasms (BPDCNs) are infrequent, poorly documented, and transient. We report a 40-year-old man presenting with bycitopenia and soft tissue infection. The bone marrow exhibited 3% abnormal cells. Immunophenotyping of these cells revealed the antigens CD45+ (dim), CD34+, CD117+, CD123+ (bright), HLA-DR+ (bimodal), CD56+ (bright), CD33+, CD13+, CD2+, and CD22+ (dim) and the partial expression of the CD10+, CD36+, and CD7+ antigens. All other myeloid, monocytic, and lymphoid antigens were negative. Genetic studies showed a complex karyotype and mutations in the TP53R337C and KRASG12D genes. On hospital admission, the patient showed a subcutaneous nodule on the right hand and left lower limb. Flow cytometry multiparameter (FCM) analysis showed the presence of 29% abnormal cells with the previously described immunophenotype. The patient was diagnosed with BPDCN. The patient was treated with broad-spectrum antibiotics for soft tissue infection, which delayed therapy for BPDCN. No steroids or chemotherapeutic or hypomethylating agents were administered. His blood cell counts improved and skin lesions disappeared, until the patient relapsed five months after achieving spontaneous remission. About 60% of abnormal cells were identified. No changes in immunophenotype or the results of genetic studies were observed. The patient underwent a HyperCVAD chemotherapy regimen for six cycles. Consolidation therapy was performed via allogeneic bone marrow transplantation with an HLA-unrelated donor. One year after the bone marrow transplant, the patient died due to the progression of his underlying disease, coinciding with a respiratory infection caused by SARS-CoV-2. In the available literature, SRs are often linked to infections or other stimulators of the immune system, suggesting that powerful immune activation could play a role in controlling the leukemic clone. Nevertheless, the underlying mechanism of this phenomenon is not clearly understood. We hypothesize that the immune system would force the leukemic stem cell (LSC) to undergo a state of quiescence. This loss of replication causes the LSC progeny to die off, resulting in the SR of BPDCN.
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页数:10
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