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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
Author(s) -
Shimonodan Hidemi,
Nagayama Jun,
Nagatoshi Yoshihisa,
Hatanaka Michiki,
Takada Akiko,
Iguchi Haruo,
Oda Yoshinao,
Okamura Jun
Publication year - 2005
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.20357
Subject(s) - medicine , lymphoblast , acute lymphocytic leukemia , osteolysis , leukemia , parathyroid hormone related protein , bone marrow , parathyroid hormone , immunology , pathology , calcium , surgery , lymphoblastic leukemia , genetics , biology , cell culture
Background Osteopathy is one of the common initial symptoms of acute lymphocytic leukemia (ALL) in children and adolescents, but multiple osteolysis accompanied by hypercalcemia is rarely observed. Procedure We treated a 14‐year‐old female who had multiple osteolytic lesions and hypercalcemia at initial onset of ALL. In this case we examined some humoral factors, which are known to associate with hypercalcemia in malignancies. Results Parathyroid hormone‐related peptide (PTHrP) was elevated in serum, and reverse transcriptase‐polymerase chain reaction and immunohistochemistry revealed that the lymphoblasts produced PTHrP directly. Other humoral factors related to hypercalcemia were not detected. ALL relapsed in the bone marrow 3 months after achieving complete remission, and hypercalcemia and elevation of serum PTHrP were also observed. A second remission could not be achieved and hypercalcemia continued. The patient received allogeneic bone marrow transplantation. The serum calcium level became normal after the conditioning therapy. Before engraftment, however, the patient died of infection. Conclusions 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. © 2005 Wiley‐Liss, Inc.