Adult acute precursor B-cell lymphoblastic leukemia presenting as hypercalcemia and osteolytic bone lesions

Nikki Charlotta Paul Granacher,Zwi N. Berneman,Wilfried Schroyens,Alain P. A. Gadisseur,Ann L. R. Van de Velde,Anke Verlinden

doi:10.1186/s40164-017-0071-8

Nikki Charlotta Paul Granacher, Zwi N. Berneman + Show 4 more

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Journal: Experimental Hematology & Oncology	Publication Date: Apr 11, 2017
Citations: 11	License type: open-access

Affiliation: Antwerp University Hospital

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BackgroundOsteolytic bone lesions and hypercalcemia without peripheral blasts B-cell acute lymphoblastic leukemia (B-ALL) is reported in children but rarely seen in adults.Case presentationWe describe the case of a 34-year old man presenting with hypercalcemia and symptomatic osteolytic bone lesions of vertebrae and ribs who was initially suspected as having a solid malignancy. Diagnostic work-up including peripheral blood examination, radiographic and nuclear studies could, however, not detect a primary tumor. Because of a mild thrombocytopenia and the lack of a primary focus, a bone marrow biopsy was performed leading to the diagnosis of Philadelphia chromosome positive precursor B-ALL. After correction of the hypercalcemia with intravenous fluid administration, corticoids and bisphosphonates, the patient was treated according to the HOVON 100 protocol achieving complete molecular remission after the first cycle of induction chemotherapy.ConclusionHypercalcemia and osteolytic bone lesions are rare complications of adult B-ALL and can occur in the absence of peripheral blastosis. With this case report we would like to emphasize the importance of clinical awareness. Immediate treatment of hypercalcemia and initiation of antileukemic treatment is mandatory as a delay of diagnosis might pose a real and possible life-threatening risk in these patients.

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Osteolytic bone lesions and hypercalcemia without peripheral blasts B-cell acute lymphoblastic leukemia (B-ALL) is reported in children but rarely seen in adults.Case presentation: We describe the case of a 34-year old man presenting with hypercalcemia and symptomatic osteolytic bone lesions of vertebrae and ribs who was initially suspected as having a solid malignancy
Hypercalcemia and osteolytic bone lesions are rare complications of adult B-ALL and can occur in the absence of peripheral blastosis. With this case report we would like to emphasize the importance of clinical awareness
In acute lymphoblastic leukemia (ALL) hypercalcemia and osteolysis are mainly described in children with B-ALL [1,2,3]

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Osteolytic bone lesions and hypercalcemia are a rare presentation of adult B-ALL with only a few cases reported worldwide (Table 1) [4,5,6,7,8]. Concomitant hypercalcemia in children is even less common with a reported incidence varying between 0.6 and 4.8% This hypercalcemic subset of patients seems characterized by relatively older age (10–20 years whereas typical age lies between 4 and 14 years), ‘aleukemic’ presentation (normal white blood cell count without peripheral blastosis) and the absence of organomegaly and lymphadenopathy. In conclusion we can state that osteolytic bone lesions and hypercalcemia as sole presentation of B-ALL in adults is extremely rare with only few cases reported worldwide. As underlying mechanisms the local lymphoblast production of several humoral tumor-derived factors (PTHrP, IL-1, IL-6, IL-11, TNF-α and beta) is postulated.

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