Introduction. Acute lymphoblastic leukemia (ALL) is very rarely presented
with diffuse osteolytic lesions and hypercalcemia. Case Outline. We report a
28-year-old male with the B-cell ALL who presented with extensive osteolytic
lesions, bone pain, hepatosplenomegaly, and pancytopenia without circulating
blasts in peripheral blood. An increased serum level of tumor necrosis factor
(TNF-?) was registered while the levels of IL-1? and IL-1? were normal. The
patient failed to achieve remission on two induction regimens but achieved
one after the successful allogeneic stem cell transplantation, which lasted
for six months, after which he developed a relapse and died. Conclusion. The
presented case may serve as a clinical demonstration of possible involvement
of TNF-? as a pathogenic factor in the evolution of osteolytic lesions that
are occasionally observed in patients with ALL. This might have relevance in
the management of such patients as chemotherapy alone may not represent the
beneficial option in this clinical context.
Levels of the soluble, 55-kilodalton isoform of tumor necrosis factor receptor in bone marrow are correlated with the clinical outcome of children with acute lymphoblastic leukemia in first recurrence
