Chronic Myeloid Leukemia Associated Hypercalcemia: A Case Report and Literature Review

Abstract

Patient: Male, 58Final Diagnosis: HypercalcemiaSymptoms: Confusion • dehydrationMedication: —Clinical Procedure: —Specialty: Endocrinology and MetabolismObjective:Rare co-existance of disease or pathologyBackground:Hypercalcemia associated with chronic myeloid leukemia (CML) is an ominous sign. Although rare, several cases have been reported and multiple pathophysiologic mechanisms have been independently proposed. We present a patient case and a literature review of the clinical presentation and mechanisms of CML-associated hypercalcemia.Case Report:A 58-year-old male with a past medical history of CML diagnosed six years earlier, presented to the emergency department with one week of acute confusion, disorientation, polyuria, and polydipsia. On physical examination, we observed tachycardia, altered mental status, and dehydration. Blood analysis revealed leukocytosis, thrombocytosis, and marked hypercalcemia (18.6 mg/dL). His chest CT scan showed diffuse lytic lesions and bone destruction concerning for diffuse bone marrow involvement. The patient was diagnosed with hypercalcemia in the context of a CML blast phase. Treatment with hydration, calcitonin, and zoledronic acid lead to control of his symptoms and normalization of his serum calcium levels. After discharged, the patient was maintained on palliative treatment and zoledronic acid management without new episodes of hypercalcemia. However, eight months later, the patient died.Conclusions:Evidence from the literature demonstrates a highly variable clinical presentation of CML-associated hypercalcemia, commonly occurring during an accelerated or a blast phase, and associated with poor survival. Multiple mechanisms could be involved and are not exclusive of each other. Better understanding of the pathophysiologic mechanisms involved in CML-associated hypercalcemia could lead to improvement in clinical and laboratory evaluation of these patients and be the foundation for the development of better management strategies and possibly target-directed therapy to positively improve prognosis.

Leukemic arthritis and severe hypercalcemia in a man with chronic myeloid leukemia: a case report and review of the literature

“…In hypercalcemic patients with CML, osteolytic bone can present with varying degrees of severity, ranging from mild to severe osteolysis, all of which can be revealed by a bone survey. There are two major mechanisms for osteolytic bone: humoral mediated and local destruction [4]. An increase in osteoclastic activity modulated by secreted circulating factors from malignant cells is the mechanism of humoral destruction [4].…”

“…There are two major mechanisms for osteolytic bone: humoral mediated and local destruction [4]. An increase in osteoclastic activity modulated by secreted circulating factors from malignant cells is the mechanism of humoral destruction [4]. Several related cytokines have been proposed as the cause of bone reabsorption, but the most recently suggested cytokine is PTHrP [10–14].…”

“…(2013) [18]70/MNRBPParathyroidectomyImatinibNRToro-Tobón et al . (2017) [4]58/M6 yearsBPHydration, calcitonin, zoledronic acidPonatinibCR in 5 days; died 8 months laterThis case (2018)35/M1 yearBPHydration, calcitonin, dexamethasoneImatinibCR in 1 week from dexamethasone; later, lost to follow-up AP accelerated phase, BP blast phase, BU busulfan, CML chronic myeloid leukemia, CMT chemotherapy, CR complete response, DAU daunorubicin, DOX doxorubicin, F female, HU hydroxyurea, IV intravenous, M male, NA not available, NR not reported, PRED prednisolone, VCR vincristine, 6MP 6-mercaptopurine…”

“…Previous studies have reported an incidence of hypercalcemia of approximately 2.5% for all types of leukemia [4]. Hypercalcemia in patients with CML is very rare, and only a limited number of cases have been reported, but if it occurs, there is a dismal prognosis [4]. We present a patient with CML who developed these two uncommon manifestations (LA followed by severe symptomatic hypercalcemia) and an extensive review of the related literature.…”

“…Hypercalcemia associated with cancer is displayed by approximately 4% of patients with cancer, and it is mainly found in patients with solid tumors such as carcinoma (CA) of the lung, CA of the breast, and CA of the esophagus [3]. Previous studies have reported an incidence of hypercalcemia of approximately 2.5% for all types of leukemia [4]. Hypercalcemia in patients with CML is very rare, and only a limited number of cases have been reported, but if it occurs, there is a dismal prognosis [4].…”