elevated alkaline phospatase

Anybody has elevated alkaline phospatase level while on Herceptin? My recent blood work showed an increase in ALP of 126. The normal range is 20-125. It has been steadily increasing since 3 months, 115,118,122 and now 126. Anybody had similar experience?


Thanks,
Julie

[michele u]

Julie,
I wouldn't worry about those numbers. Mine has been going up and down for months. It can be increased with alot of different reason. Medication espicially. If it were cancer related it would up more then that!

Julie,
First... 126 ALP when normal is 125 is NOT high! In fact, you will find regional differences in that "high" number, some suggesting that 135 is normal. Allow at least 10% margin for error.
ALP can be influenced by a variety of things: neulasta, neupogen, wine, etc.

I've attached below an article on reasons why it may be elevated:



Causes of high alkaline phosphatase include bone growth, healing fracture, acromegaly, osteogenic sarcoma, liver or bone metastases, leukemia, myelofibrosis, and rarely myeloma. Alkaline phosphatase is used as a tumor marker.1,2
In rickets and osteomalacia, serum calcium and phosphorus are low to normal, and alkaline phosphatase may be normal or increased.

Hypervitaminosis D may cause elevations in alkaline phosphatase.

In Paget disease of bone there is often isolated elevation of serum alkaline phosphatase. Some of the highest levels of serum ALP are seen in Paget disease.

Hyperthyroidism, by its effects upon bone, may elevate alkaline phosphatase. There is evidence that thyroid hormone (T3) acts to stimulate bone alkaline phosphatase activity through an osteoblast nuclear receptor-mediated process.3

Hyperparathyroidism, in some patients. Pseudohyperparathyroidism.

Chronic alcohol ingestion (in chronic alcoholism, alkaline phosphatase may be normal or increased, but often with high AST (SGOT) and/or high bilirubin and especially with high GGT; MCV may be high).

Biliary obstruction (tenfold increase may be seen with carcinoma of the head of pancreas, choledocholithiasis); cholestasis; GGT also high. Cholecystitis with cholangitis. (In most patients with cholecystitis and cholangitis who do not have a common duct stone, alkaline phosphatase is within normal limits or only slightly increased.) Sclerosing cholangitis (eg, with ulcerative colitis), although importantly, 3% of cases of symptomatic sclerosing cholangitis may have normal serum ALP.4 Endoscopic retrograde cholangiography might be considered then in patients with diseases known to be associated with primary sclerosing cholangitis and with appropriate symptomatology even though ALP level is normal. Primary or metastatic tumor in liver: there may be marked increase and GGT is often high. Only three laboratory markers were consistently abnormal, in evaluating for metastatic carcinoma of breast, prior to clinical detectability of metastases: these were alkaline phosphatase, GGT and CEA.2

Cirrhosis, especially in primary biliary cirrhosis, in which fivefold or more increases are seen.

Gilbert syndrome: Increase in intestinal alkaline phosphatase is seen.5

Hepatitis: Moderate increases in alkaline phosphatase occur in viral hepatitis, but greater elevations of the transaminases (AST (SGOT), ALT (SGPT)) are usually found.

Fatty metamorphosis of liver (moderate increase occurs in acute fatty liver).

Diabetes mellitus, diabetic hepatic lipidosis.

Infiltrative liver diseases (eg, sarcoid, TB, amyloidosis, abscess).

Sepsis. Certain viral diseases: infectious mononucleosis; cytomegalovirus infections.

Postoperative cholestasis. Pancreatitis, carcinoma of pancreas, cystic fibrosis.

Pulmonary infarct (1-3 weeks after embolism. Healing infarcts in other organs, including kidney, may also cause increased alkaline phosphatase); other situations in which angiofibroplasia occurs, such as healing in a large decubitus ulcer.

Tumors, especially hypernephroma; neoplastic ectopic production (Regan, Nagao isoenzymes).

Fanconi syndrome.

Peptic ulcer, erosion. Intestinal strangulation or obstruction, or ulcerative lesion. Steatorrhea, malabsorption (from bone, secondary to vitamin D deficiency). Ulcerative colitis with pericholangitis, other erosive lesions of colon.

Congestive heart failure.

Parenteral hyperalimentation of glucose, intravenous albumin administration.

Familial hyperphosphatasemia.

Idiopathic.

Drugs – estrogens (large doses), birth control agents, methyltestosterone, phenothiazines, oral hypoglycemic agents, erythromycin, or any drug producing hypersensitivity or toxic cholestasis. Many commonly and uncommonly used drugs elevate alkaline phosphatase, and tenfold increases may be seen with drug cholestasis.

Julie,
I had a similar experience with my alk phos elevating after the completion of chemo. It was checked every 3 months or so with my other liver enzymes. The others always remained normal but the alk phos jumped around from high normal to 10 or so points above. Bone activity can elevate the alk pnos and I had a lot of bone loss due to chemo induced menapause. I had a DEXA bone density test done which showed the rapid loss (osteoopenia). Once the bone activity settled down my alk phos has stayed in the normal range.

Hi Julia, I hadn't needed blood tests before I got BC, so when I had my first in 1998 my Alk Ph was 142 in red writing, and ever since then it has been up to as much as 165 which it is at the moment, at one stage this year I actually had one in the normal range, it can't be explained, but also sorts of suspicians, fractured left shoulder with collapsed humeral head which makes the bone break down, I have Horishimots thyroid but only for last 3 years, I take a truck load of drugs and vitamins, none of my symptoms are related to bone mets or any other mets and at the moment I am having problems with my other shoulder, try not to worry, easy said I know, but when I asked my onc about bone mets he said, you'll know by the pain, so it had to be worse than the pain I went through with my fracture, and boy that was painful. Hope this helps, the results are mostly a guide and my CA-15.3 tumor maker has always been under 30.

Hugs Lyn

Hi, Julie,

I read the other posts, but I will just tell you what I have noticed. If the ALK Phos is showing a worrisome and continuing upward trend into the 100's, in my experience, this has represented minor bone mets, usually will correlate with just one spot lighting up on the CT...if the number goes into the 250-300, 400 range, it generally means extensive bone mets, provided that the liver enzymes are stable. If you have elevated alk phos and elevated liver enzymes, it is usually liver mets (have had those too). Right now, the liver is quiet but my alk phos is doing exactly what yours is and I am correlating it to pain in my sternum which is where I light up on the bone scan. I think another bone scan would be a good bet, just in case. Also, just remember that just keeping the CA 15.3 below 30 is not always good enough when her-2 is involved. This marker is similar to the CA 27/29 and in order for the serum her-2 levels to be within normal range, the CA 27/29 can not be much higher than 10 to 15...fyi. Look at the whole picture. What are your calcium blood levels...are they increasing as well?? Good luck to you, Gina

My calcium blood levels are stable and liver engymes are very much stable and normal. I am not sure waht is causing ALP to rise, can cold increase this?

regards,
Julie

Julie,

The Alk phos can also rise when bone is repairing itself. Did you injure yourself anywhere...even twist an ankle?? Still, given your ER-PR- her-2+++ status which is the same as mine and as you probably know, tends to be rather aggressive, I would have a bone scan just to know for sure what you are dealing with. If it turns out one little place lights up, there is much that can be done right away..maybe just slightly increasing your herceptin dosage...but if it is serious and you wait ... a bunch of nasties might light up like a tree on Christmas morning and that would not be good. As I always say where her-2 is concerned..."better to know EVEN a dark and terrible truth, than not to know it"..Conrad?? I think ?? Also, if you want to advoid a bone scan, check your CA 27/29 and serum her-2 to see where you are. If the CA 27/29 is less than 15 and the her-2 less than 12, you are probably ok as far as cancer mets are concerned.

Also, thank you for responding to the negative blood inquiry...I was wondering if your your MOM had negative blood, though,...just curious. Still, thanks for your info as you are ER-PR-HER-2+++ you will make a good control case for positive -blooded folks as I investigate the ratios of negative blood with her-2 to positive. Will keep you "posted"...good luck on the Alk phos and congratulations on keeping such a well-trained eye on your blood chem.

Many thanks, Gina