Hypercalcemia associated with all-trans-retinoic acid in the treatment of acute promyelocytic leukemia.
Recent reports have described clinical benefits of all-trans-retinoic acid (ATRA) therapy for acute promyelocytic leukemia (APL). This paper describes severe hypercalcemia (serum calcium: 18.7 mg/dl) in association with ATRA treatment in a 14 year old girl with APL. Serum parathyroid hormone (PTH) concentrations were normal (0.21 ng/ml), which precludes the possibility of primary hyperparathyroidism or ectopic PTH secretion as a cause of the hypercalcemia. As for the factors which can accelerate mineral resorption, there were no apparent increases in the levels of PTH-related protein (PTH-rP), prostaglandins and vitamin D metabolites. In our in vitro experiment, ATRA did not stimulate the leukemic cells to produce PTH-rP. We speculate that ATRA, like PTH, may increase osteoclastic activity and induce hypercalcemia.
Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan.
M
M
Sakakibara
M
M
Ichikawa
Y
Y
Amano
S
S
Matsuzawa
K
K
Agematsu
T
T
Mori
K
K
Koike
T
T
Nakahata
A
A
Komiyama
D000293:Adolescent; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000139:chemically induced* / Q000150:complications; D015473:Leukemia, Promyelocytic, Acute / Q000150:complications / Q000188:drug therapy*; D044162:Parathyroid Hormone-Related Protein; D011506:Proteins / Q000378:metabolism; D014212:Tretinoin / Q000009:adverse effects* / Q000627:therapeutic use
C470121:PTHLH protein, human; D044162:Parathyroid Hormone-Related Protein; D011506:Proteins; D014212:Tretinoin