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Multiple myeloma-induced hyperammonemic encephalopathy: an entity associated with high in-patient mortality

Anthony Pham1, John L Reagan, Jorge J Castillo

  • 1Division of Hematology and Oncology, Mayo Clinic, Rochester, MN, USA.

Leukemia Research
|August 13, 2013
PubMed

Insights

Multiple myeloma (MM) can rarely cause hyperammonemic encephalopathy. Treating MM significantly improves survival rates for this rare but serious complication.

Area of Science:

  • Hematology
  • Neurology
  • Oncology

Background:

  • Hyperammonemia is a rare complication of multiple myeloma (MM).
  • Hyperammonemic encephalopathy in MM patients has been infrequently documented.

Purpose of the Study:

  • To describe the clinical characteristics and outcomes of patients with MM-induced hyperammonemic encephalopathy.
  • To evaluate the impact of MM-directed therapy on mortality in these patients.

Main Methods:

  • Retrospective case series including 6 patients from the institution and 34 from literature review.
  • Analysis of patient demographics, MM subtypes, ammonia levels, and treatment outcomes.

Main Results:

  • The median age of affected patients was 67 years (male:female ratio 1.8:1).
  • Median ammonia level was 114 umol/L; IgG and IgA MM were common subtypes.
  • Overall in-patient mortality was 48%; mortality was 31% with MM-directed therapy versus 100% without.

Conclusions:

  • Hyperammonemic encephalopathy is a rare but critical complication of multiple myeloma.
  • Prompt MM-directed therapy is associated with improved survival in patients with this condition.
Keywords:
AmmoniaEncephalopathyMyeloma

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