Thursday, July 25, 2013

Topic Discussion: Hypercalcemia and leukemias..( not lymphomas)

Classically, one associates hypercalecmia of malignancy with solid tumors such as breast cancer, kidney cancer and so forth. In regards to hematologic cancers, the lymphomas, and myelomas are the two disease states that have shown to have hypercalcemia.

Does AML, ALL and other leukemias have associated hypercalcemia? It’s rare. T cell leukemia classically associated with HTLV-1 has been widely reported and is the most common leukemia to have hypercalcemia. Besides that, the rest of them are 1-2 case reports. NEJM had one of the earlier cases of this association. Recently, childhood ALL was reported with hypercalcemia of malignancy as a result of parathyroid hormone-related peptide and E2A-HLF from translocation 17; 19.  Shu et al discuss the mechanism involved in leukemias and hypercalcemia. Cancer type T cell leukemia has a 50-90% incidence of hypercalcemia and its pthrp mediated or interleukin mediated or perhaps RANKL mediated. Acute non lymphocytic leukemia has a rare incidence but its pthrp and or 1,25 Vitamin D mediated.

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