Peer Review Report For: Case Report: Spontaneous remission of early T-cell precursor acute lymphoblastic leukemia [version 1; peer review: 1 approved with reservations]

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Background: Spontaneous remission (SR) has been reported in different hematological malignancies. It has been observed in adult T-cell lymphoma, chronic lymphocytic leukemia (CLL) and myelodysplastic syndrome (MDS). It is generally associated with recovery from an infectious or immunological process, and more recently possibly with clonal hematopoiesis. Case: We reviewed the literature and reported a new case of a 40 year-old man with a morphologic and cytogenetic diagnosis of early T-cell precursor acute lymphoblastic leukemia (ALL) associated with an appendicular abscess. During his hospitalization and surgical management of his appendicitis, we noted SR of the rate of blast cells until cytological and cytogenetic remission of his ALL but unfortunately it did not last too long, moreover our patient relapsed after nine months, received intensive chemotherapy, underwent a placental blood allograft but relapsed again and died. Conclusions: In contrast to SR in other types of cancer, all documented cases of SR in ALL were only transient, so is there a need for early cytotoxic therapy in SR in ALL to delay relapse?

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