Hypercalcemia and osteolytic lesions as presenting symptoms of acute lymphoblastic leukemia in childhood. The use of zoledronic acid and review of the literature

Abstract

Hypercalcemia is rare in children with etiology different from adults. We report an 11.5-year-old boy with developmental delay that presented with difficulty in walking and vomiting. Laboratory investigations revealed hypercalcemia (Ca 13.8 mg/dL) with low serum parathormone, normal full blood count and no circulating blasts. Osteolytic lesions were discovered on radiological survey. Bone marrow examination was consistent with the diagnosis of common B acute lymphoblastic leukemia (ALL). Hypercalcemia was successfully treated with zoledronic acid. Hypercalcemia is a rare but well-recognized complication of ALL, usually present at the time of initial diagnosis. We reviewed the literature and analyzed the clinical and laboratory data in 36 cases of childhood ALL presenting with hypercalcemia. In conclusion, hypercalcemia alone or combined with osteolytic lesions can be the only presenting symptom of ALL in children.

Hypercalcaemia with disseminated osteolytic lesions: a rare presentation of childhood acute lymphoblastic leukaemia

“…Our patient did not respond to diuresis, steroids, or calcitonin and required bisphosphonates which rapidly corrected the hypercalcaemia [ 13 ]. In the series by Inukai et al [ 7 ], 10 of 12 patients required i.v.…”

Severe Hypercalcemia in a Child With Acute Lymphoblastic Leukemia Relapse

“…Only 2 case reports (11.5-and 15-year-old boys) have been found in English literature about ZA use in hypercalcemia of children with the diagnosis of ALL. 20,21 Hypercalcemia was diagnosed at the time of initial diagnosis of ALL in both cases, whereas it was developed during relapse in our case. ZA had been successfully used as a first-line agent in the treatment of hypercalcemia in both cases.…”

“…ZA had been successfully used as a first-line agent in the treatment of hypercalcemia in both cases. 20,21 In contrast, pamidronate was used as a first-line treatment agent in our case, because ZA was unavailable in our clinic despite it being a more potent agent than pamidronate. 22 In addition, calcium normalization has been reported at the fourth day of ZA administration in a study on adults with malignancy-associated hypercalcemia.…”

Atypical Presentation of Acute Lymphoblastic Leukemia in a 7 Year Old Child

“…The invasion of leukemic cells disrupts the normal hematopoietic microenvironment resulting in an expansion of osteoclasts causing increased bone resorption and a concomitant reduction of osteoblastic activity [7]. Further, parathyroid hormone related protein (PTrH) secreted by tumor cells cause bone resorption [8]; but, normal parathyroid hormone is suppressed due to feedback mechanism [9]. In addition, various inflammatory cytokines like tumor necrosis factor alpha (TNF-a), interleukins are released and results in bone erosion [8].…”