Hypercalcemia in childhood acute lymphoblastic leukemia: frequent implication of parathyroid hormone-related peptide and E2A-HLF from translocation 17;19

• DOI: 10.1038/sj.leu.2404496
• Publication Date: 2006-12-21T11:07:50Z
• Authors: T Inukai; K Hirose; T Inaba; H Kurosawa; A Hama; H Inada; M Chin; Y Nagatoshi; Y Ohtsuka; M Oda; H Goto; M Endo; A Morimoto; M Imaizumi; N Kawamura; Y Miyajima; M Ohtake; R Miyaji; M Saito; A Tawa; F Yanai; K Goi; S Nakazawa; K Sugita
• Keywords: Male; Adolescent; Oncogene Proteins, Fusion; Reverse Transcriptase Polymerase Chain Reaction; Parathyroid Hormone-Related Protein; Reproducibility of Results; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Translocation, Genetic; 3. Good health; DNA-Binding Proteins; 03 medical and health sciences; 0302 clinical medicine; Child, Preschool; Hypercalcemia; Humans; Calcium; Female; Child; Chromosomes, Human, Pair 19; Chromosomes, Human, Pair 17; Transcription Factors

Hypercalcemia is relatively rare but clinically important complication in childhood leukemic patients. To clarify the clinical characteristics, mechanisms of hypercalcemia, response to management for hypercalcemia, incidence of t(17;19) and final outcome of childhood acute lymphoblastic leukemia (ALL) accompanied by hypercalcemia, clinical data of 22 cases of childhood ALL accompanied by hypercalcemia (>12 mg/dl) reported in Japan from 1990 to 2005 were retrospectively analyzed. Eleven patients were 10 years and older. Twenty patients had low white blood cell count (<20 x 10(9)/l), 15 showed hemoglobin> or =8 g/dl and 14 showed platelet count > or =100 x 10(9)/l. Parathyroid hormone-related peptide (PTHrP)-mediated hypercalcemia was confirmed in 11 of the 16 patients in whom elevated-serum level or positive immunohistochemistry of PTHrP was observed. Hypercalcemia and accompanying renal insufficiency resolved quickly, particularly in patients treated with bisphosphonate. t(17;19) or add(19)(p13) was detected in five patients among 17 patients in whom karyotypic data were available, and the presence of E2A-HLF was confirmed in these five patients. All five patients with t(17;19)-ALL relapsed very early. Excluding the t(17;19)-ALL patients, the final outcome of ALL accompanied by hypercalcemia was similar to that of all childhood ALL patients, indicating that the development of hypercalcemia itself is not a poor prognostic factor.