Abstract
Acute lymphoblastic leukaemia (ALL) presenting with hypercalcaemia and lytic bone lesions is a rare event in children unlike adults. We report a 15-year-old boy with acute lymphoblastic leukaemia and hypercalcaemia. He had normal peripheral blood count and the peripheral smear did not show blast. The bone marrow examination revealed Pre B ALL phenotype with aberrant expression of CD13. The skeletal survey showed osteolytic lesions. Hypercalcaemia was treated with zoledronic acid. He attained remission only after three lines of intensive chemotherapy protocols. He was planned for stem cell transplant. Meanwhile, he relapsed and died. A review of the literature also highlights characteristics similar to our case.
Highlights
Acute lymphoblastic leukaemia (ALL) is one of the commonest malignancies in children and adolescents
ALL with unfavourable cytogenetics is treated with intensive chemotherapy followed by stem cell transplant
We report a 15-year-old boy with ALL who presented with disseminated bone lesions and impending pathological fracture along with hypercalcaemia
Summary
Acute lymphoblastic leukaemia (ALL) is one of the commonest malignancies in children and adolescents. We report a 15-year-old boy with ALL who presented with disseminated bone lesions and impending pathological fracture along with hypercalcaemia He had a chemorefractory disease and attained remission only after the third line of intensive chemotherapy. Cerebrospinal fluid (CSF) cytology was negative for malignant cells He was initially treated with saline diuresis, frusemide, steroids, and i.v. calcitonin for the first three days to ameliorate the severe hypercalcaemia; his calcium continued to be persistently elevated and serum creatinine showed rising trend. He received single dose of injection zoledronic acid 4 mg i.v. and was started on ALL induction chemotherapy with BFM-95 protocol. Within a short span of less than one month, he relapsed and died
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