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Hypercalcemia in the accelerated phase of chronic myelogenous leukemia
Insights
Severe hypercalcemia can occur in accelerated phase chronic myelogenous leukemia and is not caused by parathyroid hormone. Mithramycin may be an effective treatment when saline diuresis is insufficient.
Area of Science:
- Hematology
- Oncology
- Endocrinology
Background:
- Chronic myelogenous leukemia (CML) is a myeloproliferative neoplasm.
- Accelerated phase CML presents unique clinical challenges.
- Hypercalcemia is a potential complication in advanced malignancies.
Observation:
- Three patients with accelerated phase CML presented with severe hypercalcemia.
- In two patients, hypercalcemia was confirmed with suppressed parathyroid hormone (PTH) levels.
Findings:
- Hypercalcemia in accelerated phase CML may be more prevalent than previously recognized.
- The hypercalcemia observed was not PTH-mediated.
- Elevated PTH levels in this context warrant investigation for primary hyperparathyroidism.
Implications:
- This finding necessitates increased awareness of hypercalcemia in accelerated phase CML.
- Non-PTH-mediated hypercalcemia requires specific management strategies.
- Mithramycin should be considered early for refractory hypercalcemia in CML, especially when saline diuresis is inadequate.
Abstract:
Within a recent one-year period, 3 patients in the accelerated phase of chronic myelogenous leukemia were admitted to our medical center with severe hypercalcemia. Simultaneous determinations of ionized calcium and parathyroid hormone levels in 2 of the patients confirmed the hypercalcemia and revealed suppression of parathyroid hormone. We conclude that hypercalcemia in the accelerated phase of chronic myelogeneous leukemia may be more common than previously described and is not mediated by parathyroid hormone. An elevated parathyroid hormone level accompanying hypercalcemia in these patients should suggest the additional diagnosis of primary hyperparathyroidism. Mithramycin was necessary for control in 2 of our cases as well as in others reported in the medical literature and should be an early therapeutic consideration whenever saline diuresis is inadequate.