Cover Image

Osteolytic Bone Lesions, Hypercalcemia, and Renal Failure: A Rare Presentation of Childhood Acute Lymphoblastic Leukemia

Keith Peterson, Rodney Higgins, Tyler Peterson, Yoav Messinger

Abstract


Introduction: Pediatric acute lymphoblastic leukemia (ALL) rarely presents with hypercalcemia and diffuse osteolytic lesions.

Presentation of Case: We report the case of a 17 year-old male with hypercalcemia, thrombocytopenia, and renal failure. Skeletal x-rays showed extensive osteolytic lesions. Pamidronate was used for treatment of hypercalcemia when calcitonin failed to maintain calcium levels within the normal range. Parathyroid hormone-related peptide (PTHrP) was not elevated. Bone marrow biopsy revealed B-precursor acute lymphoblastic leukemia. The patient failed two induction regimens but achieved remission after lymphoma-like chemotherapy. He continues to be in remission 7 years after double cord-blood transplantation.

Conclusions: The present case is used to explore the etiology and treatment of hypercalcemia associated with pediatric ALL, and to review the literature concerning the prognostic significance of multiple osteolytic lesions in a pediatric leukemia patient.


Keywords


Acute lymphoblastic leukemia; Hypercalcemia; Osteolytic bone lesions

Full Text:

PDF

References


McKay C, Furman WL. Hypercalcemia complicating childhood malignancies. Cancer. 1993;72:256-260.

Hibi S, Funaki H, Ochiai-Kanai R, et al. Hypercalcemia in children presenting with acute lymphoblastic leukemia. Int J Hematol. 1997, 66:353-357

Lankisch P, Kramm C, Hermsen D, et al. Hypercalcemia with nephrocalcinosis and impaired renal function due to increased parathyroid hormone secretion at onset of childhood acute lymphoblastic leukemia. Leuk Lymphoma. 2004, 45:1695-1697

Mundy GR. Pathophysiology of cancer-associated hypercalcemia. Semin Oncol. 1990, 17:10-15

Roux S, Mariette X. Hematological malignancies and the bone (myeloma excluded). Joint, Bone, Spine. 2000, 67:264-271

Todo S, Imashuku S, Inoda H, et al. Hypercalcemia in a case of childhood acute lymphoblastic leukemia. Jpn J Clin Oncol. 1987, 17:357-362

Choi SJ, Cruz JC, Craig F, et al. Macrophage inflammatory protein 1-alpha is a potential osteoclast stimulatory factor in multiple myeloma. Blood. 2000, 96:671-675

Sarma U, Flanagan AM. Macrophage colony-stimulating factor induces substantial osteoclast generation and bone resorption in human bone marrow cultures. Blood. 996, 88:2531-2540

National Center for Biotechnology information (NCBI), U.S. National Library of Medicine, 8600 Rockville Pike, Bethesda, MD: Gene ID: 8600, updated on 14-Apr-2013

Shimonodan H, Nagayama J, Nagatoshi Y, et al. Acute lymphoblastic 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. Pediatr Blood Cancer. 2005, 45:333-339

Andiron N, Ayfer A, Serhan K, et al. Use of bisphosphanonates for resistant hypercalcemia in children with acute lymphoblastic leukemia: report of two cases and review of the literature. The Turkish Journal of Pediatrics. 2006, 48:248-252

Müller HL, Horwitz AE, Kühl J, et al. Acute lymphoblastic leukemia with severe skeletal involvement: a subset of childhood leukemia with a good prognosis. Pediatr Hematol Oncol. 1998, 15:121-133

Kai T, Ishii E, Matsuzaki A, et al. Clinical and prognostic implications of bone lesions in childhood leukemia at diagnosis. Leuk Lymphoma. 1996, 23:119-123

Rajantie J, Jääskeläinen J, Perkkiö M, et al. Prognostic significance of primary bone changes in children with acute lymphoblastic leukemia. Pediatr Radiol. 1985, 15:242-244

Wessels G, Hesseling PB, van der Merwe HP. Bone involvement in childhood acute lymphoblastic leukaemia. East Afi Med J. 1996, 73:126-8

Aur RJ, Westbrook HW, Riggs W. Childhood acute lymphocytic leukemia. Initial radiological bone involvement and prognosis. Am J Dis Child. 1972, 124:653-4

Hann IM, Gupta S, Palmer M, et al. The prognostic significance of radiological and symptomatic bone involvement in childhood acute lymphoblastic leukemia. Med Pediatr Oncol. 1979, 6:51-55

Bellini F, Masera G, Carnelli V, et al. Routine whole skeleton x-ray investigation of 116 children with leukemia. Ann Radiol. 1976, 19:83-86

Mancini AF, Rosito P, Vitelli A, et al. Prognostic significance of osseous lesions in acute lymphoblastic leukemia in children. Pediatr Med Chir. 1983, 5:547-549

Masera G, Carnelli V, Ferrara M, et al. Prognostic significance of radiological bone involvement in childhood acute lymphoblastic leukaemia. Arch Dis Child. 1977, 52:530-533

Heinrich SD, Gallagher D, Warrior D, et al. The prognostic significance of the skeletal manifestations of acute lymphoblastic leukemia of childhood. J Pediatr Orthop. 1994, 14:105-11

Soni PN. Hypercalcemia and multiple osteolytic lesions in childhood acute lymphoblastic leukaemia. Postgrad Med J. 1993, 69:483-485


Refbacks

  • There are currently no refbacks.


AJCC-REP (ISSN 2572-5742)Copyright © 2012-2020. All rights reserved. Published by Ivy Union Publishing, 3204 Valley Rush Dr, Apex, North Carolina 27502, United States