Chronic Myeloid Leukemia Associated Hypercalcemia: A Case Report and Literature Review

Hypercalcemia in Chronic Myeloid Leukemia: An Unusual Presentation

Hypercalcemia in CML is an unusual paraneoplastic syndrome and is associated with worse prognosis and reduced survival. It usually seen in blast crisis or accelerated phase but can also indicate bony infiltration by cancer cells. Multiple mechanisms can be involved in a patient. We present a case of hypercalcemia in CML in chronic phase without bony infiltration or increased parathormone levels. Increased calcium levels may also be first indication of tyrosine kinase inhibitor resistance. Patient was managed symptomatically with subsequent change of the drug for managing CML. He is currently stable at six months follow-up. Therefore, careful evaluation of the cause of hypercalcemia is necessary for appropriate management.

Signaling pathways involved in chronic myeloid leukemia pathogenesis: The importance of targeting Musashi2-Numb signaling to eradicate leukemia stem cells

OBJECTIVES

Chronic myeloid leukemia (CML) is a myeloid clonal proliferation disease defining by the presence of the Philadelphia chromosome that shows the movement of BCR-ABL1. In this study, the critical role of the Musashi2-Numb axis in determining cell fate and relationship of the axis to important signaling pathways such as Hedgehog and Notch that are essential for self-renewal pathways in CML stem cells will be reviewed meticulously.

MATERIALS AND METHODS

In this review, a PubMed search using the keywords of Leukemia, signaling pathways, Musashi2-Numb was performed, and then we summarized different research works .

RESULTS

Although tyrosine kinase inhibitors such as Imatinib significantly kill and remove the cell with BCR-ABL1 translocation, they are unable to target BCR-ABL1 leukemia stem cells. The main problem is stem cells resistance to Imatinib therapy. Therefore, the identification and control of downstream molecules/ signaling route of the BCR-ABL1 that are involved in the survival and self-renewal of leukemia stem cells can be an effective treatment strategy to eliminate leukemia stem cells, which supposed to be cured by Musashi2-Numb signaling pathway.

CONCLUSION

The control of molecules /pathways downstream of the BCR-ABL1 and targeting Musashi2-Numb can be an effective therapeutic strategy for treatment of chronic leukemia stem cells. While Musashi2 is a poor prognostic marker in leukemia, in treatment and strategy, it has significant diagnostic value.

Acute Lymphoblastic Leukemia with Malignant Hypercalcemia: A Case Report

Patient: Female, 6

Final Diagnosis: Acute lymphoblastic leukemia

Symptoms: Abdominal pain • bloody diarrhea • malaise • vomiting

Medication: —

Clinical Procedure: Chemotherapy

Specialty: Oncology

Leukemic arthritis and severe hypercalcemia in a man with chronic myeloid leukemia: a case report and review of the literature

Background

Patients with chronic myeloid leukemia typically present with high white blood cell counts revealed during annual checkups. Leukemic arthritis and hypercalcemia are rare manifestations in patients with chronic myeloid leukemia.

Case presentation

A 35-year-old Thai man who had been diagnosed with chronic myeloid leukemia in the chronic phase developed blast crisis while he was receiving ongoing treatment with imatinib at 400 mg/day. Initially, he presented with oligoarthritis in both knees and ankles. A bone scintigraphy showed a prominent bony uptake, with a symmetrical, increased uptake in many bone areas. Induction therapy with a 7 + 3 induction regimen was prescribed in conjunction with 600 mg of imatinib once daily before switching to 140 mg of dasatinib. He subsequently developed severe hypercalcemia (total serum calcium of 17.8 mg/dL), with generalized osteolytic lesions detected on a bone survey. His serum vitamin D level was 50.64 ng/mL, while the serum parathyroid hormone level was 9.82 pg/mL. Despite the administration of an aggressive intravenously administered hydration, intravenously administered calcitonin, and 600 mg/day of imatinib, the severe hypercalcemia was refractory. We therefore decided to prescribe 20 mg/day of intravenously administered dexamethasone; fortunately, his serum calcium level decreased dramatically to normal range within a few days.

Conclusions

Although leukemic arthritis and severe hypercalcemia are extraordinary presentations in patients with chronic myeloid leukemia, the advanced phase of the disease might bring on these symptoms. Apart from parathyroid hormone-related protein-related hypercalcemia, vitamin D is a mechanism of humoral-mediated hypercalcemia.

Electronic supplementary material

The online version of this article (10.1186/s13256-018-1798-5) contains supplementary material, which is available to authorized users.