Hypercalcemia of Malignancy: Time to Pull the Brakes.

Hypercalcemia of malignancy (HOM) is usually seen in advanced stage and carries a poor prognosis. Survival outcomes are dismal and most of the patients are unable to receive subsequent definite anti-cancer therapy. There is lack of any retrospective or prospective data regarding hypercalcemia of malignancy in Indian population. We aim to describe survival outcomes in hypercalcemia associated with solid organ malignancies. Forty-five patients diagnosed with HOM associated with solid organ malignancies were included in the study. Patients were followed up till death. Clinical features and survival outcomes were noted. Squamous cell carcinoma of head and neck region and lung comprised most of the cases associated with HOM. Most of the patients presented with poor performance status. Median overall survival (OS) was 20 days (2-78 days). Median OS was 35 days (9-58 days) in those who received definite anti-cancer therapy. Four-week mortality rate was estimated as 59.5%, while this increased to 75.7% within 6 weeks from the diagnosis of hypercalcemia. Survival outcomes are poor after the diagnosis of hypercalcemia in cancer patients. Best supportive care including hospice care should be strongly considered at this point of time instead of definite systemic anti-cancer therapy.

Bone Marrow Metastases from Solid Organ Cancer in Adults.

Solid organ cancers infrequently metastasize to bone marrow (BM). BM involvement by cancer in adults leads to poor prognosis and it becomes difficult to provide appropriate treatment. We aimed to study the clinical, pathological and radiological characteristics of adult patients with BM involvement at our institute. Eleven adult patients diagnosed with BM involvement associated with solid organ cancer were included in the study. Clinical, laboratory, radiological and treatment details were analysed. Carcinoma of the breast accounted for majority of the cases. Most of the patients had poor performance status (PS) at diagnosis. Serum lactate dehydrogenase (LDH) was found to be elevated in all cases. Serum alkaline phosphatase (ALP) was elevated in all except 1 case. Median overall survival (OS) was 91 days. BM involvement from solid organ cancer in adults predicts a poor outcome. Serum LDH and serum ALP can serve as a marker of BM involvement.

Leptomeningeal relapse in primary cutaneous DLBCL: Implications for a prophylactic CNS therapy.

BACKGROUND: Isolated leptomeningeal relapse in a case of cutaneous lymphoma is an uncommon event more so in a case of primary cutaneous diffuse large B-cell lymphoma (PCDLBCL). This phenomenon is of great significance as the subsequent prognosis becomes poor and the prophylactic central nervous system (CNS) therapy if administered, can reduce the chances of relapse, however, the survival benefit remains uncertain. The role of prophylactic CNS therapy is not well defined in the case of PCDLBCL. CASE: We report a case of PCDLBCL leg type with a low CNS International Prognostic Index (CNS-IPI) risk, who developed isolated leptomeningeal relapse in the form of bilateral facial nerve palsy. He was managed by 2nd line chemotherapy and CNS directed therapy and achieved complete remission. CONCLUSION: PCDLBCL leg type is an aggressive malignancy. Molecular/genomic mechanism likely responsible for CNS dissemination should be identified by prospective multi-centric studies that can better define the subsets of patients eligible for prophylactic therapy in the absence of a high CNS-IPI risk.

Evaluation of Iron Status in Patients of Solid Organ Malignancies: Study from a Cancer Research Centre.

Anemia associated with cancer is a major public health issue. The gravity of this problem is likely to be higher in India due to already existing malnutrition in the general population. Iron deficiency anemia (IDA) as a subset has not been evaluated in Indian population of cancer patients. This study was undertaken to evaluate iron status among newly diagnosed advanced-stage cancer patients with anemia at a cancer research institute in India. Sixty-four patients of anemia were identified who fulfilled the inclusion criteria. Iron status was noted. Absolute iron deficiency (AID) was identified in 8 (12.5%) patients. Functional iron deficiency (FID) was seen in 48 (75%) patients. Probable functional iron deficiency (PFID) was seen in 2 (3.1%) patients while no iron deficiency (NID) was seen in 6 (9.3%) patients. FID is seen in majority of advanced-stage solid organ cancer patients in India. Large sample studies are required to better define the exact prevalence of iron deficiency, chemotherapy-induced anemia, and anemia in cancer subtypes.