Hypercalcemia as the Presenting Feature of T-Cell Lymphoid Blast Crisis of Ph-Positive Chronic Myeloid Leukemia

Abstract

Hypercalcemia is a rare complication of chronic myeloid leukemia (CML), usually seen in the accelerated or blastic phases of the disease and associated with a poor prognosis. T-cell lymphoid phenotype is also an infrequent finding in the blast crisis (BC) of CML. A CML patient who had hypercalcemia as the presenting feature of a T-cell BC is reported. She was a 78 year-old woman who, at four months of CML diagnosis, developed weakness, bone pain, and mental confusion, with hypercalcemia being subsequently found. Although the peripheral blood and bone marrow were consistent with the chronic phase of CML, mediastinal enlargement, a soft tissue mass adjacent to the iliac bone, and multiple osteolytic lesions were seen. Serum levels of parathyroid hormone (PTH) and PTH-related peptide were normal, whereas the search for a second neoplasm was negative. The hypercalcemia initially responded to conventional treatment, but it reappeared two weeks later. Coincidentally, a high proportion of blast cells of T-cell origin at the cortical thymocyte stage were observed in the patient's peripheral blood and bone marrow, and she died shortly afterwards.

Long-term imatinib therapy promotes bone formation in CML patients

“…18,[30][31][32][33] The increase in TBV observed in imatinib-treated patients appears to be de novo bone formation, as most CML patients had trabecular bone volumes within normal ranges at diagnosis. Changes in bone morphometry are extremely rare in chronic-phase CML patients, 22,34 with most patients having normal TBV and osteoclast numbers before treatment. 23 The increase in TBV is unlikely to be attributable to a return to normal bone marrow cellularity after eradication of leukemic cells, as most ␣-interferon treated CML patients who experienced a significant decrease in tumor burden showed no substantive increase in TBV.…”

p210 BCR-ABL1 positive pediatric B-lineage acute lymphoblastic leukemia presenting with hypercalcemia

“…[10] Though aggressive CMLs (accelerated phase and blast crisis) with paraneoplastic hypercalcemia have been described in adults, a direct causative role of Ph chromosome in the pathogenesis of hypercalcemia is yet defined. [11][12][13] Median age of children with ALL complicated by hypercalcemia is eight years, as opposed to the age of our patient who was merely 18 months old. [9] Symptoms of hypercalcemia include emesis, lethargy and bone pain.…”

Leukemic arthritis and severe hypercalcemia in a man with chronic myeloid leukemia: a case report and review of the literature

“…(2000) [13]57/M6 yearsBPHydration, corticosteroids, calcitoninHUCR32/M0APHydration, corticosteroids, calcitoninHUCRNadal et al . (2001) [16]78/F4–5 monthsBPHydration, PRED, diuretic, pamidronateVCR, adriamycinRapid CR; died 1 month laterLima et al . (2002) [25]35/F2 yearsBPPRED, pamidronateCyclophosphamide, DOX, VCRCR in 1 week; died 1 month laterMiyoshi et al .…”