Severe hypercalcaemia and extensive osteolytic lesions in an adult patientwith T cell acute lymphoblastic leukaemia

Hypercalcaemia is a rare feature of acute lymphoblastic leukaemia (ALL) in adults, particularly of the T cell type. We report on a 24-year-old patient with T-ALL, who presented with symptoms of hypercalcaemia (vomitus, acute renal failure), bone pain, extensive osteolytic lesions and normal white ce ll count without circulating blasts. An increased serum tumor necrosis fact or (TNF-alpha) concentration of 35 pg/ml was found; it remained elevated at 52 pg/ml four weeks later, after having achieved haematological remission. Serum concentrations of IL-1 beta, IL-6 and IL-2 were within the control r ange, The pathophysiology of hypercalcaemia in malignancy and possible medi ators of bone resorption, in particular TNF-alpha, are discussed.