Hypercalcemia in a patient with B-cell acute lymphoblastic leukemia: A role of proinflammatory cytokine

The complication of hypercalcemia is reported to occur only in 2.5-4.8% of patients with acute lymphoblastic leukemia (ALL). We herein report a 53-yea r-old female patient with early B-cell ALL, complicated with extreme hyperc alcemia (15.2 mg/dL). Bone X-ray revealed osteolytic changes in many locati ons. Serum 1,25(OH)(2)vitaminD(3) and parathyroid hormone(PTH) levels were suppressed below normal ranges on admission. The circulating parathyroid ho rmone-related protein (PTHrP) value was within a normal range (< 1.1 pmol/L ). Serum concentrations of tumor necrosis factor (TNF)-alpha, interleukin ( IL)-6, and soluble IL-2 receptor were increased to 72 pg/ml, 25.3 pg/ml, an d 1469 U/ml, respectively. Following the induction chemotherapy, the serum calcium level was promptly normalized accompanied with decreases in serum T NF-alpha, IL-6 and soluble IL-2 receptor values to 34 pg/ml, 6.35 pg/ml, an d 737 U/ml, respectively. Serum PTHrP values remained within detectable lev els. To our knowledge, this is the first case of B-cell ALL in a patient wh o developed hypercalcemia with elevated concentrations of TNF-alpha, IL-6, and soluble IL-2 receptor, but not related to PTHrP. High circulating proin flammatory cytokines may have contributed to development of ALL-induced ost eolysis and hypercalcemia in the present case.