Hypercalcemia in a patient with B-cell acute lymphoblastic leukemia: a role of proinflammatory cytokine.
The complication of hypercalcemia is reported to occur only in 2.5-4.8% of patients with acute lymphoblastic leukemia (ALL). We herein report a 53-year-old female patient with early B-cell ALL, complicated with extreme hypercalcemia (15.2 mg/dL). Bone X-ray revealed osteolytic changes in many locations. Serum 1,25(OH)2vitaminD3 and parathyroid hormone (PTH) levels were suppressed below normal ranges on admission. The circulating parathyroid hormone-related protein (PTHrP) value was within a normal range (< 1.1 pmol/L). Serum concentrations of tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, and soluble IL-2 receptor were increased to 72 pg/ml, 25.3 pg/ml, and 1469 U/ml, respectively. Following the induction chemotherapy, the serum calcium level was promptly normalized accompanied with decreases in serum TNF-alpha, IL-6 and soluble IL-2 receptor values to 34 pg/ml, 6.35 pg/ml, and 737 U/ml, respectively. Serum PTHrP values remained within detectable levels. To our knowledge, this is the first case of B-cell ALL in a patient who developed hypercalcemia with elevated concentrations of TNF-alpha, IL-6, and soluble IL-2 receptor, but not related to PTHrP. High circulating proinflammatory cytokines may have contributed to development of ALL-induced osteolysis and hypercalcemia in the present case.
Fukasawa
H
H
First Department of Medicine, Hamamatsu University School of Medicine, Japan. fukasawa@akiha.hama-med.ac.jp
Kato
A
A
Fujigaki
Y
Y
Yonemura
K
K
Furuya
R
R
Hishida
A
A
D014408:Biomarkers, Tumor / Q000097:blood*; D001853:Bone Marrow / Q000473:pathology; D001859:Bone Neoplasms / Q000097:blood* / Q000150:complications*; D002051:Burkitt Lymphoma / Q000097:blood* / Q000150:complications* / Q000000981:diagnostic imaging; D002117:Calcitriol / Q000097:blood; D016207:Cytokines / Q000097:blood*; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000209:etiology*; D015850:Interleukin-6 / Q000097:blood; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000097:blood; D010281:Parathyroid Hormone / Q000097:blood*; D044162:Parathyroid Hormone-Related Protein; D011506:Proteins / Q000378:metabolism; D011859:Radiography; D011877:Radionuclide Imaging; D015375:Receptors, Interleukin-2 / Q000097:blood; D012888:Skull Neoplasms / Q000097:blood / Q000150:complications; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D014408:Biomarkers, Tumor; D016207:Cytokines; D015850:Interleukin-6; D009363:Neoplasm Proteins; C470121:PTHLH protein, human; D010281:Parathyroid Hormone; D044162:Parathyroid Hormone-Related Protein; D011506:Proteins; D015375:Receptors, Interleukin-2; D014409:Tumor Necrosis Factor-alpha; D002117:Calcitriol