The Effectiveness of Combined Medical Therapy and Hemodialysis for Hypercalcemia in Anaplastic Lymphoma Kinase-negative Anaplastic Large Cell Lymphoma

Abstract

A 71-year-old man with a right lower abdominal quadrant epithelial tumor developed gradually worsening lumbago and dysbasia. He became comatose and was admitted to our hospital. He had swelling of the left axillary lymph nodes and necrosis of the 4.0-cm diameter abdominal tumor, which infiltrated the subcutaneous tissues. He was hypercalcemic (16.7 mg / dl) , and had elevated levels of soluble interleukin-2 receptor (24,090 U / ml) and parathyroid hormone- related protein (5.4 pmol / l) . Computerized tomography (CT) showed left axillary lymphadenopathy, splenomegaly, and a right abdominal-wall mass that was described as anaplastic large cell lymphoma upon pathology. Brain radiography and CT revealed multiple lesions infiltrating the cranium. Magnetic resonance imaging showed diffuse low signal intensity throughout the vertebral spine. The patient was diagnosed with anaplastic lymphoma kinase (ALK) -negative anaplastic large cell lymphoma with hypercalcemia. Fluid replacement and drug therapies including calcitonin had no effect on the hypercalcemia or the coma. The patients serum calcium concentration decreased after hemodialysis (calcium dialysate concentra- tion, 5 mg / dl) and subsequent zoledronic acid hydrate therapy. His consciousness improved by thefth day of treatment. This rare case of hypercalcemia in ALK- negative anaplastic large cell lymphoma improved with combined medical and hemodialysis therapy.