Acute lymphocytic leukemia in adolescence with multiple osteolytic lesions and hypercalcemia mediated by lymphoblast‐producing parathyroid hormone‐related peptide: A case report and review of the literature

Shimonodan, Hidemi; Ni, Jun; Nagatoshi, Yoshihisa; Hatanaka, Michiki; Takada, Ayako; Iguchi, Haruo; Oda, Yoshinao; Okamura, Jun

doi:10.1002/pbc.20357

Cited by 50 publications

(33 citation statements)

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“…However, as there was no difference in the final outcome of survival or renal insufficiency between the patients treated with and without bisphosphonate, the usefulness of bisphosphonate in treating hypercalcemia that develops in ALL patients must be confirmed in a future large prospective study. Table 5 summarizes the characteristics of 12 previously reported cases of t(17;19)-ALL [9][10][11][14][15][16]34,35 in addition to five cases identified in the present study. Hypercalcemia developed in 10 of 14 cases: four patients at their original diagnosis and six patients at disease recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…1,3,4 Hypercalcemia in malignancy is frequently mediated with parathyroid hormone-related peptide (PTHrP) by increasing osteoclastic bone resorption, renal resorption of calcium and renal phosphate loss. 5,6 Although several case reports showed the involvement of PTHrP in childhood ALL complicated with hypercalcemia, [7][8][9] its significance remains to be confirmed in a larger study. t(17;19)(q21-q22;p13), which generates E2A-HLF fusion transcription factor, 10,11 is a rare translocation present in less than 1% of childhood ALL cases, 12 and its association with hypercalcemia, acquired coagulation abnormalities and extremely poor therapeutic outcome has been noticed.…”

Section: Introductionmentioning

confidence: 99%

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Hypercalcemia in childhood acute lymphoblastic leukemia: frequent implication of parathyroid hormone-related peptide and E2A-HLF from translocation 17;19

et al. 2006

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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 (412 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 (o20 Â 10 9 /l), 15 showed hemoglobinX8 g/dl and 14 showed platelet count X100 Â 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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hypercalcemia in childhood acute lymphoblastic leukemia: frequent implication of parathyroid hormone-related peptide and E2A-HLF from translocation 17;19

et al. 2006

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“…Reverse transcriptase-polymerase chain reaction and immuno histochemistry showed in one study that lymphoblasts produced PTHrP directly [6]. Multiple osteolytic lesions with necrosis of bone marrow has also been reported in pediatric patients [7].…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Adult Acute Lymphoblastic Leukemia Presenting with Paraparesis and Multiple Osteolytic Lesions

Verma

Dubashi

Basu

et al. 2013

Indian J Hematol Blood Transfus

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Acute lymphoblastic leukemia presenting with bone involvement and multiple osteolytic lesions has been commonly reported in pediatric population. Various myeloid and lymphoid malignancies can rarely present with bony lesions. We are reporting an adult female patient with acute lymphoblastic leukemia who presented with paraparesis and multiple osteolytic lesions in skull initially giving false impression of multiple myeloma.

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“…Proinflamatuvar sitokinlerin hematopoetik öncül hücrelerin farklılaş-masını sağlayan reseptör aktivatör nükleer kappa B ligand (RANKL) üzerinden osteoklastların maturasyon ve çoğalmalarını uyararak kemik yıkımı yaptığı düşünülmektedir. Erişkin T hücreli lösemide RANKL düzeylerinde artış gösterilmiştir (5) . İlk kez bir akciğer kanseri vakasında gösterilen PTHrP'nın ise öncelikle kalsiyum ve fosfatın renaltübüler transportunu etkileyerek hiperkalsemi yaptığı düşü-nülmektedir (6) .…”

Section: Discussionunclassified

Hemodiafiltration in Treatment of a Patient with Hypercalcemia and Acute Lymphoblastic Leukemia

Aygün¹,

Koç²,

Aygün³

et al. 2016

Cocuk Dergisi

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GİrİŞSerum kalsiyum düzeyinin 12 mg/dL'nin üzerinde olması olarak tanımlanan hiperkalsemi bulantı-kusma, kabızlık gibi özgün olmayan bulguların yanında aritmi, böbrek yetersizliği, hipertansiyon ve asidoza neden olabilir. Hiperkalsemi saptanan hastalarda kesinlikle altta yatan bir hastalık araştırılmalı-dır. Hiperkalsemi erişkinlerde multiplmiyelom, lenfoma, meme, akciğer ve böbrek kanserleri sırasında %20-%30 oranında görülebilmektedir (1) . Erişkin kanserlerinde kemik metastazı olmadan hiperkalsemi varlığı ilk defa 1930 yılında tanımlanmıştır (2) . Çocuklarda ise hiperkalsemi ile bulgu veren maligniteler %0.4-1.3 gibi ender bir orandadır (3) . Çocukluk çağının en sık görülen malignitesi olan ALL ateş, solukluk, lenfadenopati, hepatosplenomegali ve kemik ağrısı ile ortaya çıkabilir ve bu yaş grubundaki malignite kaynaklı hiperkalseminin en sık nedenidir. VAkA SUNUmUDaha önce tamamen sağlıklı olan 11 yaşında kız hasta boyun sağ tarafında son 4 aydır ortaya çıkan şişlik nedeniyle kulak burun boğaz polikliniğine baş-

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Acute lymphocytic leukemia in adolescence with multiple osteolytic lesions and hypercalcemia mediated by lymphoblast‐producing parathyroid hormone‐related peptide: A case report and review of the literature

Abstract: The present case suggests that blast-producing PTHrP might be associated with multiple osteolytic lesions and hypercalcemia. PTHrP expressed in the lymphoblasts may, in itself, confer a survival advantage to lymphoblasts and contribute to the refractory nature of the disease.

Cited by 50 publications

References 33 publications

Hypercalcemia in childhood acute lymphoblastic leukemia: frequent implication of parathyroid hormone-related peptide and E2A-HLF from translocation 17;19

Hypercalcemia in childhood acute lymphoblastic leukemia: frequent implication of parathyroid hormone-related peptide and E2A-HLF from translocation 17;19

A Rare Case of Adult Acute Lymphoblastic Leukemia Presenting with Paraparesis and Multiple Osteolytic Lesions

Hemodiafiltration in Treatment of a Patient with Hypercalcemia and Acute Lymphoblastic Leukemia

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