Reactions 1347 - 16 Apr 2011

SAntineoplastics

Hypocalcaemia?: case reportA 90-year-old man was diagnosed with Hodgkin’s

lymphoma and developed hypocalcaemia during treatmentwith an AVD chemotherapy regimen. He was laterswitched to ACOPP chemotherapy and his hypocalcaemiaworsened [routes and dosages not stated].

The man received AVD chemotherapy, composed ofdoxorubicin [adriamycin], vinblastine and dacarbazine.After 3 weeks his calcium levels, which had been normal atthe time of his diagnosis, were below normal.

He received calcium gluconate and calcium carbonateand his serum calcium levels improved slightly. Hecompleted 3 cycles of AVD and was then managedconservatively. His hypocalcaemia was less severe, butpersisted.

About 9 months after his lymphoma was diagnosed, heprogresed. ACOPP chemotherapy with doxorubicin,cyclophosphamide, vinblastine, procarbazine andprednisolone was initiated and his calcium levels fell again.He was asymptomatic, and was treated with calcitrol andan increased calcium intake. His intact parathyroidhormone level was low-normal, and increased afterchemotherapy completion. He was subsequentlyhospitalised with muscle weakness, and repeated calciumrepletion was only minimally effective. Furtherinvestigation revealed a mild decrease in magnesium levelswhich was also resistant to treatment. ACOPP waswithdrawn after 4 cycles and he continued to receivecalcitrol. His ionized calcium level normalised 10 monthsafter the end of chemotherapy.

Author comment: The man had "normocalcemia beforereceiving chemotherapy, with a substantial decrease within3 weeks after receiving AVD. . . Direct suppression ofparathyroid hormone or altered calcium sensing bychemotherapeutic agents may be the cause, although theprecise mechanism of the possible hypocalcemic effect couldnot be determined in our patient."Ajero PME, et al. Chemotherapy-induced hypocalcemia. Endocrine Practice 16:284-290, No. 2, Mar-Apr 2010. Available from: URL: http://dx.doi.org/10.4158/ep09137.ra - USA 803053108

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Reactions 16 Apr 2011 No. 13470114-9954/10/1347-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved