PTHrP-independent hypercalcemia with increased proinflammatory cytokines and bone resorption in two children with CD19-negative precursor B acute lymphoblastic leukemia

Hidetaka Niizuma, Kunihiro Fujii, Atsushi Sato, Ikuma Fujiwara, Junji Takeyama, Masue Imaizumi

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Hypercalcemia in childhood acute lymphoblastic leukemia (ALL) is rare and occasionally associated with parathyroid hormone-related protein (PTHrP). However, the pathogenesis of PTHrP-independent hypercalcemia remains unclear. We report two children with precursor B ALL who had marked hypercalcemia (15.8 and 16.6 mg/dl, respectively) and disseminated osteolysis. Serum tumor necrosis factor-α (TNF-α) and IL-6 were markedly elevated, whereas 1,25(OH)2 vitamin D3, intact PTH and PTHrP were decreased or undetected. Analysis of urinary deoxypyridinoline (DPY) or bone biopsy of the osteolytic lesion showed an increased bone resorption, and administration of bisphosphonate improved the hypercalcemia. Patients had ALL with immunophenotype positive for CD10, CD34, and HLA-DR but negative for CD19 and obtained remission with chemotherapy. These findings suggest that increased osteoclastic bone resorption via stimulation with TNF-α and IL-6 may be mechanism causing PTHrP-independent hypercalcemia in some patients with precursor B ALL lacking CD19 expression.

Original languageEnglish
Pages (from-to)990-993
Number of pages4
JournalPediatric Blood and Cancer
Volume49
Issue number7
DOIs
Publication statusPublished - 2007 Dec 1

Keywords

  • Bone resorption
  • CD19
  • Hypercalcemia
  • IL-6
  • Precursor B ALL
  • TNF-α

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

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