Section of Hematology and Oncology, Department of Medicine, and.
Department of Medicine, Boston Medical Center; and.
J Natl Compr Canc Netw. 2020 Apr;18(4):420-427. doi: 10.6004/jnccn.2019.7370.
This retrospective analysis describes the prevalence of and risk factors associated with the development of hypocalcemia in patients with cancer receiving bone-modifying agents (BMAs) as supportive care.
Patients with cancer treated with an intravenous or subcutaneous BMA, including pamidronate, zoledronic acid, or denosumab, at a tertiary care/safety net hospital in 2005 through 2015 were included in this retrospective review. We reviewed the medical records for predictive clinical and laboratory parameters and for patient outcomes.
A total of 835 patients with cancer received at least one dose of a BMA during the specified time frame; 205 patients (25%) developed hypocalcemia of CTCAE grade ≥1 within 8 weeks of BMA initiation, 18 of whom (8.8%) had grade ≥3, and 3 patients died as a result. Multivariate analysis showed that patients with hematologic malignancy (odds ratio [OR], 1.956; P=.025), bone metastases (OR, 2.443; P=.017), inpatient status (OR, 2.592; P<.001), and deficient baseline vitamin D levels (OR, 2.546; P<.023) were more likely to develop hypocalcemia. Hypercalcemia before BMA administration (OR, 0.474; P=.032) was protective.
Certain patient populations, including those with hematologic malignancies and/or bone metastases, warrant closer monitoring of calcium levels while receiving BMAs because of the high rate of hypocalcemia. Low pretreatment vitamin D levels are associated with the development of hypocalcemia. These data support close monitoring of calcium levels in patients with cancer receiving BMAs, in addition to adequate repletion of vitamin D before initiation of BMAs when possible.
本回顾性分析描述了癌症患者在接受骨修饰剂（BMA）作为支持性治疗时发生低钙血症的流行情况和相关风险因素。
本回顾性研究纳入了 2005 年至 2015 年期间在一家三级保健/保障医院接受静脉或皮下 BMA（包括帕米膦酸、唑来膦酸或地舒单抗）治疗的癌症患者。我们回顾了病历以评估预测性临床和实验室参数以及患者结局。
共有 835 例癌症患者在指定时间范围内接受了至少一剂 BMA；205 例（25%）在 BMA 起始后 8 周内发生 CTCAE 分级≥1 的低钙血症，其中 18 例（8.8%）为≥3 级，3 例患者死亡。多变量分析显示，血液系统恶性肿瘤患者（比值比 [OR]，1.956；P=.025）、骨转移患者（OR，2.443；P=.017）、住院患者（OR，2.592；P<.001）和基线维生素 D 水平不足的患者（OR，2.546；P<.023）更易发生低钙血症。BMA 给药前发生高钙血症（OR，0.474；P=.032）具有保护作用。
某些患者群体，包括血液系统恶性肿瘤和/或骨转移患者，在接受 BMA 治疗时需要更密切地监测血钙水平，因为低钙血症的发生率较高。低预处理维生素 D 水平与低钙血症的发生相关。这些数据支持在接受 BMA 治疗的癌症患者中密切监测血钙水平，并在可能的情况下在开始 BMA 治疗前充分补充维生素 D。
