title: Hypercalcemia with multiple osteolytic lesions and increased circulating tumor necrosis factor in an adult patient with B-cell acute lymphoblastic leukemia.
abstract: BACKGROUND
  Acute lymphoblastic leukemia (ALL) is very rarely presented with diffuse osteolytic lesions and hypercalcemia.
  
  
  METHODS
  We report a 28-year-old male with the B-cell ALL who presented with extensive osteolytic lesions, bone pain, hepatosplenomegaly, and pancytopenia without circulating blasts in peripheral blood. An increased serum level of tumor necrosis factor (TNF-α) was registered while the levels of IL-1α and IL-1β were normal. The patient failed to achieve remission on two induction regimens but achieved one after the successful allogeneic stem cell transplantation, which lasted for six months, after which he developed a relapse and died.
  
  
  CONCLUSIONS
  The presented case may serve as a clinical demonstration of possible involvement of TNF-α as a pathogenic factor in the evolution of osteolytic lesions that are occasionally observed in patients with ALL. This might have relevance in the management of such patients as chemotherapy alone may not represent the beneficial option in this clinical context.
authors.forename: Mariana
authors.initials: M
authors.lastname: Virijevic
authors.forename: Ana
authors.initials: A
authors.lastname: Vidović
authors.forename: Natasa
authors.initials: N
authors.lastname: Colović
authors.forename: Irena
authors.initials: I
authors.lastname: Djunić
authors.forename: Mirjana
authors.initials: M
authors.lastname: Mitrović
authors.lastname: Nada Suvajdzić-Vuković
authors.forename: Dragica
authors.initials: D
authors.lastname: Tomin
mesh_terms: D000328:Adult; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology*; D008297:Male; D010014:Osteolysis / Q000000981:diagnostic imaging / Q000209:etiology*; D010384:Pelvic Bones / Q000000981:diagnostic imaging; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000276:immunology / Q000628:therapy; D011859:Radiography; D012886:Skull / Q000000981:diagnostic imaging; D013131:Spine / Q000000981:diagnostic imaging; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology
chemical_list: D014409:Tumor Necrosis Factor-alpha