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An instructive case of hypercalcemia preceding relapse of AML following allogeneic BMT

Bone Marrow Transplantation volume 46, pages 1028–1029 (2011)Cite this article

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Hypercalcemia is rarely seen in childhood malignancies and the incidence has been reported to range from 0.4 to 1.3%.1 The most common malignancies associated with hypercalcemia include AML and lymphoma, and solid tumors such as rhabdomyosarcoma and neuroblastoma. Among the hematological malignancies, hypercalcemia is an extremely rare complication of ALL.2 We report on an 18-year-old male BMT recipient who presented with profound hypercalcemia and bone pain that preceded relapse of monosomy 7-positive AML by 3 weeks.

An 18-year-old man presented with low back and left knee pain 38 days after a matched sibling allogeneic BMT for multiply relapsed monosomy 7-positive AML. Following transplant, he demonstrated no signs or symptoms of GVHD and remained on cyclosporine for GVHD prophylaxis. Within 48 h of admission, his left knee had become markedly swollen and painful. Initial laboratory evaluation revealed an elevated serum calcium level of 13.4 mg per 100 mL that later peaked at 16.2 mg per 100 mL. The serum phosphate level was also elevated at 6.6 mg per 100 mL. A complete blood count showed a WBC count of 3900 × 103/mm3 with no blasts, hemoglobin concentration of 8.4 g per 100 mL and platelet count of 30 000/mL. BM testing revealed significant fibrosis and <5% blasts, inconsistent with a diagnosis of relapse. Flow cytometry performed on marrow blood demonstrated only a small myeloblast population (1.4% of the total number of cells) that was positive for CD13, CD33, CD34, CD45 and HLA-DR.

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References

  1. Kerdudo C, Aerts I, Fattet S, Chevret L, Pacquement H, Doz F et al. Hypercalcemia and childhood cancer: a 7-year experience. J Pediatr Hematol Oncol 2005; 27: 23–27.

    Article  Google Scholar 

  2. Qayed M, Ahmed I, Valentini RP, Cushing B, Raipurkar M . Hypercalcemia in pediatric acute megakaryocytic leukemia. J Pediatr Hematol Oncol 2009; 31: 373–376.

    Article  Google Scholar 

  3. Kounami S, Yoshiyama M, Nakayama K, Hiramatsu C, Aoyagi N, Yoshikawa N . Severe hypercalcemia in a child with nonlymphocytic leukemia: the role of parathyroid hormone-related protein and proinflammatory cytokines. Acta Haematol 2004; 112: 160–163.

    Article  Google Scholar 

  4. Muler JH, Valdez R, Hayes C, Kaminski MS . Acute megakaryocytic leukemia presenting as hypercalcemia with skeletal lytic lesions. Eur J Haematol 2002; 68: 392–396.

    Article  Google Scholar 

  5. Montoliu J, Macia J, Salamero P, Parra R, Gallart M . Severe hypercalcemia indicating relapse of acute myelocytic leukemia after bone marrow transplantation. Nephron 1992; 62: 357–358.

    Article  CAS  Google Scholar 

  6. Fukasawa H, Kato A, Fujigaki Y, Yonemura K, Furuya R, Hishida A . Hypercalcemia in a patient with B-cell acute lymphoblastic leukemia: a role of proinflammatory cytokine. Am J Med Sci 2001; 322: 109–112.

    Article  CAS  Google Scholar 

  7. Kent AB, Weinstein RS . Case report: Hypercalcemia in acute myeloblastic leukemia is caused by osteoclast activation. Am J Med Sci 1993; 306: 169–173.

    Article  CAS  Google Scholar 

  8. Trehan A, Cheetham T, Bailey S . Hypercalcemia in acute lymphoblastic leukemia: an overview. J Pediatr Hematol Oncol 2009; 31: 424–427.

    Article  Google Scholar 

  9. Seymour JF, Gagel RF . Calcitriol: The major humoral mediator of hypercalcemia in Hodgkin's disease and non-Hodgkin's lymphomas. Blood 1993; 82: 1383–1394.

    CAS  PubMed  Google Scholar 

  10. Huang L, Cheng YY, Chow LT, Zheng MH, Kumta SM . Tumour cells produce receptor activator of NF-κB ligand (RANKL) in skeletal metastases. J Clin Pathol 2002; 55: 877–878.

    Article  CAS  Google Scholar 

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  1. Penn State Hershey Children's Hospital, Hershey, PA, USA

    M Huang, M Bayerl & K Lucas

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  1. M Huang
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  2. M Bayerl
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  3. K Lucas
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Correspondence to M Huang.

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Huang, M., Bayerl, M. & Lucas, K. An instructive case of hypercalcemia preceding relapse of AML following allogeneic BMT. Bone Marrow Transplant 46, 1028–1029 (2011). https://doi.org/10.1038/bmt.2010.228

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