A 71-year-old female was admitted because of fever and malaise. Physically marked pallor was noted. Laboratory investigation revealed severe leukopenia and anemia which required frequent blood transfusions. A bone marrow aspirate showed a markedly hypocellular marrow with 55.6% blast cells. Peroxidase activity and PAS reaction were negative in the blast cells. Surface markers of the blast cells, such as T, B, or myeloid antigens, were all negative except for the Ia like antigen.
A diagnosis of hypoplastic leukemia was made and in September, 1985, treatment with alfacalcidol (2-4 μg, daily) was started. Under this treatment the hemogram showed remarkable improvement and the patient became symptom-and transfusion-free. A bone marrow aspirate in November, 1985, demonstrated regeneration of normal hemopoietic cells with distinct reduction of blast cells (5.4%). From January, 1986, the leukemia became gradually refractory to alfacalcidol. The dosage of the drug was elevated up to 8 μg/day and administrated intermittently with a cycle of 5 days to minimize the side effects. However, this treatment was not helpful and the bone marrow examined in February, 1986, showed a recurrence of the leukemia. In March, 1986, the hemogram returned to pancytopenia and transfusions were needed. At the end of March, 1986, low dose Ara-C (7.5 mg/day) was started in addition to alfacalcidol (3 μg/day) without any benefitial effect.
During the treatment with alfacalcidol there was no hypercalcemia, although urinary calcium levels occasionally exceeded the normal range.
This patient is the first reported case of acute leukemia successfully treated with alfacalcidol alone.
Incubation of the bone marrow cells obtained in March, 1986, with 1α, 25 (OH)
2D
3 for 1 to 5 days, resulted in the dose-dependent reduction of absolute number of cells. While, no evidence of differentiation of leukemic cells was obtained, suggesting cytostatic effect of 1α, 25 (OH)
2D
3 rather than induction of differentiation in this patient.
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