B-CLL IN PLL TRANSFORMATION ASSOCIATED WITH HYPERCALCEMIA

A 64-Year-old woman is reported with Stage I (Rai) chronic lymphocytic leukaemia (CLL), in whom hypercalcemia developed when an increased pr oportion of prolymphocytic cells characterized a formation of CLL in p rolymphocytoid leukaemia (CLL/PL). Although hypercalcemia is more freq uently found in T-cell leukaemia associated with human T lymphotoropic lymphocyte type I, scattered reports indicate that patients with B-CL L can also be affected with this metabolic disturbance. The case descr ibed here, progressed with an indolent course of CLL for 26 months, wh en she was admitted with a very aggressive disease characterized by a high WBC count, splenomegaly and hypercalcemia. Despite an effort to a chieve a clinical remission, she failed treatment and death was attrib uted to unresponsive hypercalcemia. The mechanism of hypercalcemia in such cases is unclear as no parathyroid adenoma or second malignant tu mor was found ante mortem. This electrolytic disturbance would appear to be a direct consequence of the transforming leukaemia and a Possibl e mechanism involving a secreted humoral factor that could lead to alt ered calcium metabolism.