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Affiliation(s)
- Qiang Lin
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, 303 Jingde Road, Suzhou, Jiangsu Province, The People's Republic of China
| | - Yanhong Li
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, 303 Jingde Road, Suzhou, Jiangsu Province, The People's Republic of China
| | - Xiaomei Dai
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, 303 Jingde Road, Suzhou, Jiangsu Province, The People's Republic of China
| | - Hanyun Tang
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, 303 Jingde Road, Suzhou, Jiangsu Province, The People's Republic of China
| | - Ruyue Chen
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, 303 Jingde Road, Suzhou, Jiangsu Province, The People's Republic of China
| | - Qinying Xu
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, 303 Jingde Road, Suzhou, Jiangsu Province, The People's Republic of China
| | - Hailong He
- Department of Hematology, Children's Hospital of Soochow University, 92 Zhongnan Street, Suzhou, Jiangsu Province, The People's Republic of China
| | - Xiaozhong Li
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, 303 Jingde Road, Suzhou, Jiangsu Province, The People's Republic of China.
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Zou R, Peng F, Yu T, Zeng S, You Y, Chen K, Zou H, Tian X, Zhu C, He X. Kasabach-Merritt syndrome combined with hypercalcemia: A case report. Exp Ther Med 2017; 14:6164-6168. [PMID: 29285174 DOI: 10.3892/etm.2017.5332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 08/04/2017] [Indexed: 11/06/2022] Open
Abstract
The present case report presented the diagnosis and treatment course of an infant diagnosed with Kasabach-Merritt syndrome (KMS) combined with hypercalcemia (HC). A 35-day-old infant with swelling on the upper right arm for >1 month and thrombocytopenia for 1 day was admitted to Hunan Provincial People's Hospital (Changsha, China) and a series of treatments, including γ-globulin impact, heparin anticoagulation, platelet transfusion, supplement of cryoprecipitate and fibrinogen following heparinization and inhabitation of vascular endothelial cell proliferation by propranolol, were performed. At 2 months after the initial admission to the hospital, surgery was conducted and the hemangioma was removed through pipeline arteriosclerosis embolization when the patient was hospitalized again with symptoms of vomiting and atrophy accompanied by HC. The level of blood calcium reduced to normal following surgery. Cases of KMS combined with HC are extremely rare and the most effective way to treat such cases is surgical resection of the hemangioma.
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Affiliation(s)
- Runying Zou
- Department of Hematology and Oncology of Children's Medical Center, Hunan Provincial People's Hospital, Changsha, Hunan 410005, P.R. China
| | - Fang Peng
- Department of Hematology and Oncology of Children's Medical Center, Hunan Provincial People's Hospital, Changsha, Hunan 410005, P.R. China
| | - Tian Yu
- Department of Hematology and Oncology of Children's Medical Center, Hunan Provincial People's Hospital, Changsha, Hunan 410005, P.R. China
| | - Saizhen Zeng
- Department of Hematology and Oncology of Children's Medical Center, Hunan Provincial People's Hospital, Changsha, Hunan 410005, P.R. China
| | - Yalan You
- Department of Hematology and Oncology of Children's Medical Center, Hunan Provincial People's Hospital, Changsha, Hunan 410005, P.R. China
| | - Keke Chen
- Department of Hematology and Oncology of Children's Medical Center, Hunan Provincial People's Hospital, Changsha, Hunan 410005, P.R. China
| | - Hui Zou
- Department of Hematology and Oncology of Children's Medical Center, Hunan Provincial People's Hospital, Changsha, Hunan 410005, P.R. China
| | - Xin Tian
- Department of Hematology and Oncology of Children's Medical Center, Hunan Provincial People's Hospital, Changsha, Hunan 410005, P.R. China
| | - Chengguang Zhu
- Department of Hematology and Oncology of Children's Medical Center, Hunan Provincial People's Hospital, Changsha, Hunan 410005, P.R. China
| | - Xiangling He
- Department of Hematology and Oncology of Children's Medical Center, Hunan Provincial People's Hospital, Changsha, Hunan 410005, P.R. China
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3
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Abstract
OBJECTIVE This study aimed to call attention to hypercalcemia, a rare finding in children which carries the potential of leading to serious complications without proper intervention. METHODS Diagnosis, treatment, and clinical course of children with sustained hypercalcemia admitted between the years 2006-2016 were reviewed. Group 1 [parathyroid hormone (PTH)-dependent] consisted of patients with high/unsuppressed PTH levels and group 2 (PTH-independent) included cases with normal/suppressed PTH levels. RESULTS Twenty patients (11 male, 9 female) with a median age of 6.25 (0.03-17.88) years were evaluated. Symptoms were mostly related with the gastrointestinal system, while six patients (30%) were asymptomatic. Physical examination findings were diverse, non-specific, and normal in four patients (20%). Median time of diagnosis was 45 (2-720) days. Patients were divided into group 1 (n=7) and group 2 (n=13). Most frequent etiologies were primary hyperparathyroidism (n=5), idiopathic infantile hypercalcemia (IIH) (n=5), and malignancy (n=4). A moderate positive correlation was noted between serum calcium and creatinine levels (r=0.53, p=0.02). Nephrocalcinosis was the most common complication (n=9) (45%). Treatment was not implemented in 2 patients with mild hypercalcemia, while other patients received medical treatment ± surgery. Treatment-resistant patients were cases of malignancies and neonatal severe hyperparathyroidism. Long-term follow-up displayed resistant hypercalciuria in three infants diagnosed as IIH. CONCLUSION Many patients with childhood hypercalcemia are asymptomatic or exhibit a non-specific and heterogeneous clinical presentation, resulting in delayed diagnosis. Mild cases may not be recognized, while symptoms may be missed in the presence of accompanying illnesses. Nevertheless, serious complications may only be avoided with prompt diagnosis and intervention.
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Affiliation(s)
- Nisa Eda Çullas İlarslan
- Ankara University Faculty of Medicine, Department of Pediatrics, Ankara, Turkey
,* Address for Correspondence: Ankara University Faculty of Medicine, Department of Pediatrics, Ankara, Turkey Phone: +90 312 595 57 63 E-mail:
| | - Zeynep Şıklar
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Merih Berberoğlu
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
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Granacher NCP, Berneman ZN, Schroyens W, Van de Velde ALR, Verlinden A, Gadisseur APA. Adult acute precursor B-cell lymphoblastic leukemia presenting as hypercalcemia and osteolytic bone lesions. Exp Hematol Oncol 2017; 6:9. [PMID: 28401025 PMCID: PMC5387187 DOI: 10.1186/s40164-017-0071-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Osteolytic bone lesions and hypercalcemia without peripheral blasts B-cell acute lymphoblastic leukemia (B-ALL) is reported in children but rarely seen in adults. CASE PRESENTATION We describe the case of a 34-year old man presenting with hypercalcemia and symptomatic osteolytic bone lesions of vertebrae and ribs who was initially suspected as having a solid malignancy. Diagnostic work-up including peripheral blood examination, radiographic and nuclear studies could, however, not detect a primary tumor. Because of a mild thrombocytopenia and the lack of a primary focus, a bone marrow biopsy was performed leading to the diagnosis of Philadelphia chromosome positive precursor B-ALL. After correction of the hypercalcemia with intravenous fluid administration, corticoids and bisphosphonates, the patient was treated according to the HOVON 100 protocol achieving complete molecular remission after the first cycle of induction chemotherapy. CONCLUSION Hypercalcemia and osteolytic bone lesions are rare complications of adult B-ALL and can occur in the absence of peripheral blastosis. With this case report we would like to emphasize the importance of clinical awareness. Immediate treatment of hypercalcemia and initiation of antileukemic treatment is mandatory as a delay of diagnosis might pose a real and possible life-threatening risk in these patients.
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Affiliation(s)
| | - Zwi N Berneman
- Division of Hematology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Wilfried Schroyens
- Division of Hematology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Ann L R Van de Velde
- Division of Hematology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Anke Verlinden
- Division of Hematology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Alain P A Gadisseur
- Division of Hematology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
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Ruella M, Barrett DM, Kenderian SS, Shestova O, Hofmann TJ, Perazzelli J, Klichinsky M, Aikawa V, Nazimuddin F, Kozlowski M, Scholler J, Lacey SF, Melenhorst JJ, Morrissette JJD, Christian DA, Hunter CA, Kalos M, Porter DL, June CH, Grupp SA, Gill S. Dual CD19 and CD123 targeting prevents antigen-loss relapses after CD19-directed immunotherapies. J Clin Invest 2016; 126:3814-3826. [PMID: 27571406 DOI: 10.1172/jci87366] [Citation(s) in RCA: 416] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 07/14/2016] [Indexed: 12/21/2022] Open
Abstract
Potent CD19-directed immunotherapies, such as chimeric antigen receptor T cells (CART) and blinatumomab, have drastically changed the outcome of patients with relapsed/refractory B cell acute lymphoblastic leukemia (B-ALL). However, CD19-negative relapses have emerged as a major problem that is observed in approximately 30% of treated patients. Developing approaches to preventing and treating antigen-loss escapes would therefore represent a vertical advance in the field. Here, we found that in primary patient samples, the IL-3 receptor α chain CD123 was highly expressed on leukemia-initiating cells and CD19-negative blasts in bulk B-ALL at baseline and at relapse after CART19 administration. Using intravital imaging in an antigen-loss CD19-negative relapse xenograft model, we determined that CART123, but not CART19, recognized leukemic blasts, established protracted synapses, and eradicated CD19-negative leukemia, leading to prolonged survival. Furthermore, combining CART19 and CART123 prevented antigen-loss relapses in xenograft models. Finally, we devised a dual CAR-expressing construct that combined CD19- and CD123-mediated T cell activation and demonstrated that it provides superior in vivo activity against B-ALL compared with single-expressing CART or pooled combination CART. In conclusion, these findings indicate that targeting CD19 and CD123 on leukemic blasts represents an effective strategy for treating and preventing antigen-loss relapses occurring after CD19-directed therapies.
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Park HJ, Choi EJ, Kim JK. A successful treatment of hypercalcemia with zoledronic acid in a 15-year-old boy with acute lymphoblastic leukemia. Ann Pediatr Endocrinol Metab 2016; 21:99-104. [PMID: 27462588 PMCID: PMC4960023 DOI: 10.6065/apem.2016.21.2.99] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/18/2016] [Accepted: 05/24/2016] [Indexed: 11/20/2022] Open
Abstract
Severe hypercalcemia in children is a rare medical emergency. We present a case of a 15-year-old boy with hypercalcemia (total calcium level, 14.2 mg/dL) with a normal complete blood count, no circulating blasts in the peripheral blood film, and no other signs of acute lymphoblastic leukemia (ALL), including no signs of lymphadenopathy or hepatosplenomegaly. The hypercalcemia was successfully treated with zoledronic acid. As hypercalcemia can be the only presenting symptom of ALL in children, the diagnosis is often delayed. In children presenting with hypercalcemia, malignancies must be considered in the differential diagnosis.
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Affiliation(s)
- Hye-Jin Park
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Eun-Jin Choi
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jin-Kyung Kim
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu, Korea
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7
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Poirée M, Dupont A, Gondon E, Boyer C, Dupont D. [Life-threatening hypercalcemia as the initial presentation of childhood acute lymphoblastic leukemia]. Arch Pediatr 2015; 22:608-12. [PMID: 25896627 DOI: 10.1016/j.arcped.2015.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 10/08/2014] [Accepted: 03/05/2015] [Indexed: 11/21/2022]
Abstract
Hypercalcemia in childhood acute lymphoblastic leukaemia (ALL) is a well-known but uncommon complication. Here, we report a case of B-ALL in which the first signs were life-threatening hypercalcemia associated with diffuse osteolytic lesions with no hematologic abnormalities. We draw attention to the difficulties formally establishing the ALL diagnosis. Bone marrow examinations must be repeated if necessary. Furthermore, biological, cytogenetic, and molecular aspects need to be investigated. Measurement of intact PTH can exclude hyperparathyroidism. PTHrP is possibly involved in hypercalcemia processes induced by tumor cells. The t(17;19) translocation and its E2A-HLF transcript fusion, which have been thought to be a poor prognostic factor, must be determined. Regarding severe hypercalcemia control, treatment is based on both underlying disease management and serum calcium level reduction with aggressive hydration and if necessary bisphosphonates.
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Hussein S, Pinkney K, Jobanputra V, Bhagat G, Alobeid B. CD19-negative B-lymphoblastic leukemia associated with hypercalcemia, lytic bone lesions and aleukemic presentation. Leuk Lymphoma 2014; 56:1533-7. [PMID: 25219596 DOI: 10.3109/10428194.2014.963579] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Shafinaz Hussein
- Department of Pathology and Cell Biology, New York Presbyterian Hospital/Columbia University Medical Center , New York, NY , USA
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Abstract
Hypercalcaemia is a common metabolic complication of malignant disease often requiring emergency intervention. Although it is more frequently associated with solid tumours, malignancy-associated hypercalcaemia (MAH) is seen in a significant number of patients with blood diseases. Its association with myeloma and adult T-cell leukaemia/lymphoma is well recognized but the incidence of hypercalcaemia in other haematological neoplasms, affecting adults and children, is less clearly defined. Haematologists need to be familiar with the clinical manifestations of, the differential diagnosis to be considered and the most effective management strategies that are currently available for MAH. The key components of management of MAH include aggressive rehydration, specific therapy to inhibit bone resorption and, crucially, treatment of the underlying malignancy. Bisphosphonates have revolutionized the management of MAH over the last 20 years, however the elucidation of molecular pathways implicated in MAH is facilitating the development of more targeted approaches to treatment.
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Affiliation(s)
- Jeremy T S Sargent
- Trinity College, and Department of Haematology & Oncology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
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Karremann M, Schreiner U, Büsing KA, von Komorowski G, Dürken M. [Acute lymphoblastic leukemia presenting without peripheral blasts but with osteolysis and hypercalcemia in an adolescent. Atypical but not rare]. Orthopade 2009; 38:752-4. [PMID: 19533085 DOI: 10.1007/s00132-009-1443-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Joint pain is one of the major symptoms in early leukemia. We report on a 16-year-old girl who presented with groin pain and an osteolytic bone lesion. Acute lymphoblastic leukemia was diagnosed, but the laboratory workup and radiologic imaging revealed atypical results. Particularly in early precursor B-cell acute lymphoblastic leukemia, comparable initial symptoms and signs have been reported in adolescents; therefore, we recommend performing a bone marrow aspiration early on in cases of suspected osteolytic bone lesions.
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Affiliation(s)
- M Karremann
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Deutschland
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Abstract
Hypercalcemia usually results in nonspecific constitutional symptoms, although it can also manifest as a life threatening metabolic emergency. It is an uncommon albeit well recognized biochemical feature of childhood malignancies including acute leukemia. The pathogenesis of hypercalcemia and its implications in terms of long-term outcome are not yet fully understood. Most of the children presenting with acute lymphoblastic leukemia and hypercalcemia tend to be in older age groups and have an absence of blasts in the peripheral blood film. The chromosomal translocation 17;19 seems to be more frequent in children who present with hypercalcemia but the presence of hypercalcemia by itself does not seem to be closely linked to prognosis. Some of the less common immunophenotypes in the form of CD19 negativity and CD10 positivity have also been observed in hypercalcemic patients. In this study, we shall illustrate this clinical problem using the details of 2 patients with hematologic malignancy who were found to be hypercalcemic at presentation. We shall also review the literature with particular emphasis on the pathogenesis of hypercalcemia, its associations, and relationship to outcome.
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Qayed M, Ahmed I, Valentini RP, Cushing B, Rajpurkar M. Hypercalcemia in pediatric acute megakaryocytic leukemia: case report and review of the literature. J Pediatr Hematol Oncol 2009; 31:373-6. [PMID: 19415024 DOI: 10.1097/MPH.0b013e31819a5d29] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hypercalcemia has been described as a possible complication of many pediatric malignancies. Here, we report an 8-month-old non-Down syndrome infant with acute megakaryocytic leukemia and severe hypercalcemia at presentation. A review of the literature reveals that this is the first case of hypercalcemia complicating acute megakaryocytic leukemia reported in the pediatric literature. His initial workup, and the course of management and outcome, is described in detail. Though the etiology of this complication remains unclear, our experience suggests that early institution of chemotherapy along with supportive care is the best treatment for control of hypercalcemia.
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Abstract
A 16 year-old boy presented with severe hypercalcemia, diffuse osteolytic lesions and vertebral fractures. He was initially diagnosed with metabolic bone disease, and the hypercalcemia responded to treatment with intravenous hydration and bisphosphonates. However, the intact parathormone level was normal. He had no lymphadenopathy or organomegaly. The only hematological abnormality was moderate anemia, which prompted bone marrow studies leading to a diagnosis of acute lymphoblastic leukemia (ALL). He was treated with standard chemotherapy and achieved remission as well as resolution of his skeletal symptoms. We discuss the diagnostic challenges of this rare entity of aleukemic leukemia with hypercalcemia and lytic bone lesions, and review all the previously reported pediatric literature.
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Affiliation(s)
- Prasanth Ganesan
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Weenig RH. Pathogenesis of calciphylaxis: Hans Selye to nuclear factor kappa-B. J Am Acad Dermatol 2008; 58:458-71. [PMID: 18206262 DOI: 10.1016/j.jaad.2007.12.006] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Revised: 11/30/2007] [Accepted: 12/04/2007] [Indexed: 01/06/2023]
Abstract
The clinical syndrome of calciphylaxis is characterized by arteriolar medial calcification, thrombotic cutaneous ischemia, necrotic skin ulceration, and a high mortality rate. This review integrates calciphylaxis risk factors with the molecular processes governing osseous and extraosseous mineralization. As the pathogenesis of calciphylaxis is better understood, targeted therapies aimed at disease prevention and reversal will follow.
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Affiliation(s)
- Roger H Weenig
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Inukai T, Hirose K, Inaba T, Kurosawa H, Hama A, Inada H, Chin M, Nagatoshi Y, Ohtsuka Y, Oda M, Goto H, Endo M, Morimoto A, Imaizumi M, Kawamura N, Miyajima Y, Ohtake M, Miyaji R, Saito M, Tawa A, Yanai F, Goi K, Nakazawa S, Sugita K. Hypercalcemia in childhood acute lymphoblastic leukemia: frequent implication of parathyroid hormone-related peptide and E2A-HLF from translocation 17;19. Leukemia 2006; 21:288-96. [PMID: 17183364 DOI: 10.1038/sj.leu.2404496] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Hypercalcemia is relatively rare but clinically important complication in childhood leukemic patients. To clarify the clinical characteristics, mechanisms of hypercalcemia, response to management for hypercalcemia, incidence of t(17;19) and final outcome of childhood acute lymphoblastic leukemia (ALL) accompanied by hypercalcemia, clinical data of 22 cases of childhood ALL accompanied by hypercalcemia (>12 mg/dl) reported in Japan from 1990 to 2005 were retrospectively analyzed. Eleven patients were 10 years and older. Twenty patients had low white blood cell count (<20 x 10(9)/l), 15 showed hemoglobin> or =8 g/dl and 14 showed platelet count > or =100 x 10(9)/l. Parathyroid hormone-related peptide (PTHrP)-mediated hypercalcemia was confirmed in 11 of the 16 patients in whom elevated-serum level or positive immunohistochemistry of PTHrP was observed. Hypercalcemia and accompanying renal insufficiency resolved quickly, particularly in patients treated with bisphosphonate. t(17;19) or add(19)(p13) was detected in five patients among 17 patients in whom karyotypic data were available, and the presence of E2A-HLF was confirmed in these five patients. All five patients with t(17;19)-ALL relapsed very early. Excluding the t(17;19)-ALL patients, the final outcome of ALL accompanied by hypercalcemia was similar to that of all childhood ALL patients, indicating that the development of hypercalcemia itself is not a poor prognostic factor.
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Affiliation(s)
- T Inukai
- Department of Pediatrics, University of Yamanashi, School of Medicine, Yamanashi, Japan.
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