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Clinical Pediatrics, Vol. 35, No. 10, 501-504 (1996)
DOI: 10.1177/000992289603501004

Benign Transient Hyperphosphatasemia in Children with Leukemia and Lymphoma

Gita V. Massey, MD

Nancy L. Dunn, M.D.

Janice L. Heckel, M.D.

Department of Pediatrics, Divisions of Hematology-Oncology, Children's Medical Center, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA

James C. M. Chan, M.D.

Department of Pediatrics, Divisions of Nephrology, Children's Medical Center, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA

E. Clifton Russell, M.D.

Department of Pediatrics, Divisions of Hematology-Oncology, Children's Medical Center, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA

A temporary elevation of serum alkaline phosphatase has been described in young children who have no evidence of liver or bone disease. This phenomenon has been termed benign hyperphosphatasemia of infancy. Its occurrence is described in three children undergoing chemotherapy for acute lymphoblastic leukemia and lymphoma. All three children were in remission and in the consolidation or maintenance phase of their therapy when the hyperphosphatasemia occurred. All children were also receiving methotrexate (IM and IV), oral 6-mercaptopurine, and oral sulfamethoxazole/trimethoprim. Although these agents are associated with hepatotoxicity, other liver transaminases (ALT, AST) remained at normal concentrations, and there was an elevation only in the bone isoenzyme of alkaline phosphatase, thus making hepatic toxicity an unlikely etiology for the hyperphosphatasemia. No alteration in chemotherapy was necessary for resolution of the elevated alkaline phosphatase in these children.


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S. Kutilek, M. Bayer, and D. Markova
Prospective Follow-up of Children with Transient Hyperphosphatasemia
Clinical Pediatrics, August 1, 1997; 36(8): 491 - 492.
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