Spontaneous remission in myelodysplastic syndrome

A 73-year-old man was admitted for investigation of pancytopenia. His physi cal examination was unremarkable and the bone marrow aspirate was compatibl e with myelodysplastic syndrome (RAEB). Cytogenetic analysis of the bone ma rrow revealed a trisomy 21. The patient received transfusions of packed red cells, and his condition remained stable for the next 7 months. He was the n admitted with a chest infection and was treated with broad-spectrum antib iotics with satisfactory response. During his hospitalization there was a g radual increase in his complete blood count values, which persisted, result ing in a normal peripheral blood after 3 months. A bone marrow aspirate per formed at that time revealed normal findings with no karyotypic abnormaliti es, indicating a spontaneous remission. The patient remained stable for the next 6 months; then he recurred with 20% blasts in his bone marrow and rea ppearance of trisomy 21in 42% of the metaphases examined. Several hematolog ic malignancies with spontaneous remissions have been described to date, bu t they have generally been short and recurrence is the rule, as in the case described. The role of endogenous cytokines in triggering these spontaneou s remissions is under question, as the exact mechanism is unknown.