Inability of short-term, low-dose hydroxychloroquine to resolve vitamin D-mediated hypercalcemia in patients with B-cell lymphoma.

Abstract

The 4-aminoquinolines, including chloroquine and hydroxychloroquine, have been successfully employed to treat patients with granuloma-forming disease-associated, vitamin D metabolite-mediated hypercalcemia. The calcium-lowering efficacy of these drugs has not been prospectively evaluated in patients with lymphoma and elevated 1,25-(OH)2D levels. Four such hypercalcemic patients with stage IV B-cell lymphoma were treated, two each, with either 400 mg daily oral hydroxychloroquine or a single course of prednisone-containing antitumor chemotherapy (CHOP). Antitumor therapy normalized the serum calcium and 1,25-(OH)2D concentration within 5 days. Over a 15-day period, hydroxychloroquine failed to reduce either the serum calcium or 1,25-(OH)2D level in lymphoma patients. In contrast, within 5 days 400 mg of hydroxychloroquine daily lowered elevated levels of calcium and 1,25-(OH)2D by 37% and 72%, respectively, in a hypercalcemic patient with sarcoidosis. These data suggest that regulation of the vitamin D-1-hydroxylase in lymphoma cells, the putative source of hormone in lymphoma patients, is refractory to the inhibitory actions of the aminoquinolines and that glucocorticoid-containing antitumor regimens are the antihypercalcemic therapies of choice in lymphoma patients with high 1,25-(OH)2D levels.

• Authors: J S Adams, V Kantorovich
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 84 Issue 2 Pg. 799-801 (Feb 1999) ISSN: 0021-972X [Print] United States
• PMID: 10022456 (Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Hydroxychloroquine
• Vincristine
• Doxorubicin
• Cyclophosphamide
• Calcitriol
• Prednisone

Topics

• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Calcitriol (blood)
• Cyclophosphamide (therapeutic use)
• Doxorubicin (therapeutic use)
• Female
• Humans
• Hydroxychloroquine (administration & dosage, therapeutic use)
• Hypercalcemia (drug therapy, etiology)
• Lymphoma, B-Cell (complications, drug therapy)
• Male
• Prednisone (therapeutic use)
• Sarcoidosis (complications)
• Vincristine (therapeutic use)