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Case Reports
. 2023 Feb 23:9:1050062.
doi: 10.3389/fmed.2022.1050062. eCollection 2022.

Does Etelcalcetide reverse myelofibrotic bone changes due to hyperparathyroidism? A case report

Vincenzo Antonio Panuccio  1   2 , Rocco Tripepi  2 , Adele Postorino  1 , Bruna Greve  3 , Elena Sabattini  4 , Esther Natalie Oliva  3
Affiliations
Case Reports

Does Etelcalcetide reverse myelofibrotic bone changes due to hyperparathyroidism? A case report

Vincenzo Antonio Panuccio et al. Front Med (Lausanne). .

Abstract

Secondary hyperparathyroidism (SHPT) in dialysis is common. A young man on chronic hemodialysis with SHPT developed pancytopenia with resistant anemia requiring transfusions. A bone marrow biopsy showed grade 3 fibrosis, depleted cellularity, osteosclerosis, and decreased myelopoiesis. He initiated Etelcalcetide 7⋅5 mg 3 times weekly with improvement in SHPT concomitant with near normalization of blood counts. Marrow biopsy at 12 months showed clearance of marrow reticulin, improvement of osteosclerosis and normalization of bone trabeculae, cellularity and myelopoiesis. This is a unique case in which Etelcalcetide treatment is comparable to parathyroidectomy on SHPT and is associated with significant improvement in severe myelofibrosis.

Keywords: Etelcalcetide; bone change; dialysis (ESKD); hyperparatiroidism; myelofibrosis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
(A) Intact PTH trend during kidney graft dysfunction period and during hemodialysis period. (B) Alkaline Phosphatase trend during kidney graft dysfunction period and during hemodialysis period.
FIGURE 2
FIGURE 2
(A) Osteo-thickening areas affecting the entire spine. (B) Osteo-thickening areas in the pelvis.
FIGURE 3
FIGURE 3
(A) First bone marrow biopsy: silver impregnation staining (x10) shows diffuse severe (grade 3) fibrosis. (B) First bone marrow biopsy: Hematoxylin Eosin (x10) shows depleted cellularity and frank osteosclerosis with bone thickening and remodeling. (C) First bone marrow biopsy: Hematoxylin Eosin (x10) shows residual decreased myelopoiesis. (D) Second bone marrow biopsy: silver impregnation staining (x10) shows variability of marrow fibrosis (severe 3 on the right side; moderate on the left side). (E) Second bone marrow biopsy: Hematoxylin Eosin (x10) shows mild improvement of the osteosclerosis. (F) Second bone marrow biopsy: Hematoxylin Eosin (x10) shows residual decreased myelopoiesis. (G) Third bone marrow biopsy: silver impregnation staining (x10) shows almost normalization of marrow fibrosis. (H) Third bone marrow biopsy: Hematoxylin Eosin (x10) shows clear-cut improvement of the osteosclerosis with normal appearing bone trabeculae. (I) Third bone marrow biopsy: Hematoxylin Eosin (x10) shows regular cellularity and myelopoiesis.
See this image and copyright information in PMC

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