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Post-Transplant Complications

Characterization and management of hypercalcemia following transplantation for osteopetrosis

Bone Marrow Transplantation volume 45, pages 939–944 (2010)Cite this article

Abstract

Autosomal recessive osteopetrosis (OP) is characterized by insufficient osteoclast activity resulting in defective bone resorption and marked increase in skeletal mass and density. OP has been successfully treated with hematopoietic cell transplantation (HCT), secondary to engraftment of donor-derived functioning osteoclasts resulting in remodeling of bone and establishment of normal hematopoiesis. Although hypercalcemia is a common presenting feature of OP, it may be observed following HCT due to engraftment of osteoclasts differentiated from the hematopoietic precursors. To characterize hypercalcemia after HCT—who is at risk, onset, duration and response to treatment—we evaluated 15 patients with OP treated at the University of Minnesota from 2000 to 2009. Hypercalcemia, defined as any single calcium >11.0 mg/100 ml after the first transplant, was found in 40% of patients. Median onset of hypercalcemia was 23 days and the duration was 2–24 days. Hypercalcemia was more common in patients older than 2 years of age at the time of HCT. Treatment with hydration, furosemide and s.c. calcitonin resolved hypercalcemia and resulted in no severe adverse events. In conclusion, hypercalcemia is common in patients with OP within the first 4 weeks after HCT, and more likely in older patients. Isotonic saline, furosemide and s.c. calcitonin were well-tolerated and effective treatments in our study population.

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Acknowledgements

This publication was supported by NIH/NCRR Grant number K12 RR023247. Its contents are the authors' sole responsibility and do not necessarily represent official NIH views. This work was supported in part by the Children's Cancer Research Fund and the Bone Marrow Transplant Research Fund.

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Author notes

  1. C Martinez and L E Polgreen: These authors contributed equally to this work.

  2. J Tolar and P J Orchard: These authors contributed equally to this work.

Authors and Affiliations

  1. Center for Cell and Gene Therapy, Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX, USA

    C Martinez

  2. Division of Endocrinology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA

    L E Polgreen & A Petryk

  3. Division of Hematology/Oncology and Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA

    T E DeFor, T Kivisto, J Tolar & P J Orchard

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  1. C Martinez
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  2. L E Polgreen
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  4. T Kivisto
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  6. J Tolar
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  7. P J Orchard
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Correspondence to C Martinez.

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The authors declare no conflict of interest. No honorarium, grant or other form of payment was given to authors to produce the paper.

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Martinez, C., Polgreen, L., DeFor, T. et al. Characterization and management of hypercalcemia following transplantation for osteopetrosis. Bone Marrow Transplant 45, 939–944 (2010). https://doi.org/10.1038/bmt.2009.277

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  • DOI: https://doi.org/10.1038/bmt.2009.277

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