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Hypercalcemia and 13‐cis‐retinoic acid in post‐consolidation therapy of neuroblastoma

We report 19 episodes of hypercalcemia in three children treated with 13‐cis‐retinoic acid (13‐cis‐RA) as a post‐consolidation therapy for high‐risk neuroblastoma. There was no concomitant overload in 13‐cis‐RA blood levels. Blood calcium fell after arrest of 13‐cis‐RA intake. Half dosage retinoid treatment resumption did not prevent the recurrence of hypercalcemia. Concomitant biological values showed massive bone resorption. Hence, hypercalcemia seemed not secondary to 13‐cis‐RA overload but rather to inter‐individual variability in its interaction with bone metabolism. Current guidelines in case of hypercalcemia are to reduce 13‐cis‐RA dosage. Instead we propose to maintain the therapeutic dosage, but to shorten the duration of courses. Pediatr Blood Cancer 2009;52:280–283. © 2008 Wiley‐Liss, Inc.