Spontaneous remission of B-cell chronic lymphocytic leukemia associated with T lymphocytic Hyperplasia in bone marrow. (Letters to the Editor).

To the Editor: I would like to add another case of possible spontaneous remission of chronic lymphocytic leukemia (CLL) to that reported by Upshaw and Callihan. (1) In September 1996, a 74-year-old woman presented with a white blood cell count of 23,000/[micro]l with 57% lymphocytes. The bone marrow biopsy specimen was hypercellular, showing CLL with diffuse and nodular involvement of lymphoid cells, including pentrabecular collections. Flow cytometry revealed an abnormal B-cell population coexpressing the CD5 T-cell marker and strongly expressing the [kappa] light chain. CD5/CD9 coexpression was 54%. These findings seemed convincing for a diagnosis of CLL. Periodic follow-up examinations were performed, but the patient was not treated for CLL. The patient's lymphocyte and white blood cell counts remained elevated until February 2002, at which time the white blood cell count was 9,600/[micro]l, with only 36% lymphocytes and 55% neutrophils. In June 2002, the white blood cell count was again normal at 7,800/[m icro]l, with an absolute lymphocyte count of 2,900/[micro]l (normal, 1,000--4,800/[micro]l). This patient appeared, at least clinically, to be in complete, continuous remission without treatment, although the bone marrow examination and immunophenotyping of the peripheral blood were not repeated. I know of another case of a 60-year-old man who in 1980 had a convincing evaluation for CLL and also experienced complete remission a few years later. He has been in complete remission since that time and is now 82 years old. There may be a small number of patients who have spontaneous, complete remission of CLL, as discussed by Upshaw and Callihan (1) and investigators cited in some of their references. This curious observation may not be known widely, and how spontaneous remission might occur seems to deserve further study.

Daniel J. Morris, MD

Naples Medical Center

Naples, FL

References

(1.) Upshaw JD Jr, Callihan TR. Spontaneous remission of B-cell chronic lymphocytic leukemia associated with T lymphocytic hyperplasia in bone marrow. South Med J 2002; 95:647-649.