[Hypercalcemia mediated by parathyroid hormone-related protein in the blastic phase of chronic myelogenous leukemia].
A 45-year-old man with chronic myelogenous leukemia (CML) in the accelerated phase was admitted to our hospital because of lower back pain and hypercalcemia. On admission, he was confused and found to have massive splenomegaly. The hypercalcemia and splenomegaly improved significantly after administration of incadronate, hydroxyurea, vincristine and prednisolone. Splenomegaly recurred after cessation of the chemotherapy, and examination of the peripheral blood showed 31% blasts, positive for both CD13 and CD33, on which basis myeloid blastic transformation was diagnosed. Vindesine, cytarabine and prednisolone were administered, and the splenomegaly improved again. On admission, when the patient's serum calcium level was 16.0 mg/dl, his serum parathyroid hormone-related protein (PTHrP) level was elevated to 118.3 pmol/l. Furthermore, RT-PCR analysis revealed that the patient's CML cells expressed PTHrP mRNA, and a high level of PTHrP was detected in the supernatant of cultured mononuclear cells derived from the patient's peripheral blood. These findings indicated that the hypercalcemia was due to production of PTHrP by the leukemic cells. Several cases of PTHrP. mediated hypercalcemia associated with CML have been reported previously, and are reviewed here.
Kakihana
Kazuhiko
K
Department of Hematology and Oncology, Tokyo Medical and Dental University.
Mizuchi
Daisuke
D
Yamaguchi
Mitsuko
M
Sakashita
Chizuko
C
Fukuda
Tetsuya
T
Yamamoto
Koh
K
Miki
Tohru
T
Tohda
Shuji
S
Koyama
Takatoshi
T
Murakami
Naomi
N
Miura
Osamu
O
D001752:Blast Crisis; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology*; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D044162:Parathyroid Hormone-Related Protein; D014176:Protein Biosynthesis; D011506:Proteins / Q000502:physiology
C470121:PTHLH protein, human; D044162:Parathyroid Hormone-Related Protein; D011506:Proteins