Malignant hypercalcemia in hematopoietic malignancies

Maligna hiperkalcemija je čest paraneoplastični sindom koji se javlja u 30% pacijenata sa solidnim i hematološkim neoplazmama, najčešće u multiplom mijelomu i agresivnim limfomima, posebno u uznapredovalom stadiju i povezuje se s lošim ishodom. U literaturi nije nađena usporedba pacijenata s dijagnozom multiplog mijeloma i tzv. ne-mijelomskih pacijenata (limfomi, leukemije) koji su tijekom svoje bolesti razvili bar jednu epizodu hiperklacemije. Cilj ove studije bio je usporediti ove dvije skupine pacijenata i utvrditi ima li razlike u kliničkim i laboratorijskim parametrima te preživljenju, preživljenju unutar mijelomskih pacijenata s obzirom na dob, ISS stadij, blagu i umjereno povišenu koncentraciju ukupnog kalcija te kappa ili lambda tipu lakih lanaca. U ovu retrospektivnu analizu bilo je uključeno ukupno 30 pacijenata, 21 s dijagnozom multiplog mijeloma i 9 nemijelomskih liječenih u Kliničkom bolničkom centru Dubrava na Odjelu za hematologiju od 2003. do trećeg mjeseca 2019. U našem uzorku pacijenata dobiveni su rezultati gdje možemo reći da nema razlike u preživljavanju pacijenta s dijagnozom mijelomom i nemijelomskih pacijenata (p=0,703). Medijan preživljavanja pacijenata s mijelomom je 30 mjeseci, a pacijenata s leukemijama i limfomima 20 mjeseci, što je klinički značajno. 90,5% pacijenata s mijelomom koji su razvili hiperklacemiju imaju povišenu razinu kreatinina u usporedbi s 55,5% nemijelomskih. Polovica pacijenata s MM (52,4%) ima povišenu koncentraciju proteina, dok većina (44,4%) nemijelomskih ima sniženu. Unutar mijelomske skupine pacijenata nismo dobili razliku u preživljavanju s obzirom na spol, ISS stadij i kappa i lambda tip multiplog mijeloma. Spearmanovim koeficijentom korelacije dobivena je pozitivna povezanost laboratorijskih parametara kreatinina i β2-mikroglobulina, ukupnog kalcija i β2- mikroglobulina, a negativna korigiranog kalcija i albumina. Kako do sada u literaturi nije objavljena slična studija, uspoređivanje s prethodnim podacima nije moguće.Malignant hypercalcemia is a common paraneoplastic syndrome that occurs in 30% of the patients with solid and hematologic neoplasms, most commonly in a multiple myeloma and aggressive lymphomas, especially in the advanced stage. It is associated with poor outcome. No comparisons have been published between patients with multiple myeloma (MM) and non-myeloma patients (lymphomas, leukemias) who developed at least one episode of hypercalcemia during their illness. The aim of this study was to compare these two groups of patients and determine if there were differences in clinical and laboratory parameters and survival as well as survival within myeloma patients considering age, ISS stage, mild and moderately elevated total calcium concentrations and kappa or lambda light chain concentrations. This retrospective study included 30 patients, 21 diagnosed with MM, and 9 with non- myeloma from Clinical Hospital Dubrava in Zagreb, Division of Hematology, treated from 2003 to March 2019. The study shows that there is no difference in the survival of myeloma patients and non-myeloma patients (p=0,703). The median survival of myeloma patients is 30 months and the survival of patients with leukemias and lymphomas is 20 months, which can be clinically significant. 90.5% of the myeloma patients who have developed hypercalcaemia have elevated creatinine levels compared with 55.5% of the non-myeloma. Half of the MM patients (52.4%) have elevated protein concentrations, while most (44.4%) of the non-myeloma patients have a low protein concentration. Within the myeloma patient group, we did not find a difference in survival with respect to gender, ISS stage, and kappa and lambda type multiple myeloma (p>0,05). A positive correlation between laboratory parameters of creatinine and β2-microglobulin as well as total calcium and β2- microglobulin has been obtained by using the Spearman correlation coefficient. However, the correlation between correction of calcium and albumin was negative. The similar study in the literature has not been published up to this date, meaning that comparison with previous data is not possible