title: Hypercalcemia in childhood acute lymphoblastic leukemia: frequent implication of parathyroid hormone-related peptide and E2A-HLF from translocation 17;19.
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.
authors.affiliation: Department of Pediatrics, University of Yamanashi, School of Medicine, Yamanashi, Japan. tinukai@yamanashi.ac.jp
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authors.lastname: Inukai
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authors.lastname: Hirose
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authors.lastname: Inaba
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authors.initials: H
authors.lastname: Kurosawa
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authors.lastname: Hama
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authors.lastname: Inada
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authors.initials: M
authors.lastname: Chin
authors.forename: Y
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authors.lastname: Nagatoshi
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authors.lastname: Ohtsuka
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authors.lastname: Oda
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authors.lastname: Goto
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authors.lastname: Endo
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authors.initials: A
authors.lastname: Morimoto
authors.forename: M
authors.initials: M
authors.lastname: Imaizumi
authors.forename: N
authors.initials: N
authors.lastname: Kawamura
authors.forename: Y
authors.initials: Y
authors.lastname: Miyajima
authors.forename: M
authors.initials: M
authors.lastname: Ohtake
authors.forename: R
authors.initials: R
authors.lastname: Miyaji
authors.forename: M
authors.initials: M
authors.lastname: Saito
authors.forename: A
authors.initials: A
authors.lastname: Tawa
authors.forename: F
authors.initials: F
authors.lastname: Yanai
authors.forename: K
authors.initials: K
authors.lastname: Goi
authors.forename: S
authors.initials: S
authors.lastname: Nakazawa
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authors.lastname: Sugita
mesh_terms: D000293:Adolescent; D002118:Calcium / Q000097:blood; D002648:Child; D002675:Child, Preschool; D002886:Chromosomes, Human, Pair 17; D002888:Chromosomes, Human, Pair 19; D004268:DNA-Binding Proteins / Q000235:genetics*; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000150:complications* / Q000235:genetics*; D008297:Male; D015514:Oncogene Proteins, Fusion / Q000235:genetics*; D044162:Parathyroid Hormone-Related Protein / Q000235:genetics*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood / Q000150:complications / Q000235:genetics*; D015203:Reproducibility of Results; D020133:Reverse Transcriptase Polymerase Chain Reaction; D014157:Transcription Factors / Q000235:genetics*; D014178:Translocation, Genetic
chemical_list: D004268:DNA-Binding Proteins; C076554:E2a-Hlf fusion protein, human; D015514:Oncogene Proteins, Fusion; D044162:Parathyroid Hormone-Related Protein; D014157:Transcription Factors; D002118:Calcium