Full-text resources of PSJD and other databases are now available in the new Library of Science.
Visit https://bibliotekanauki.pl


Preferences help
enabled [disable] Abstract
Number of results
2014 | 1 | 1 |

Article title

Hyperammonemia, an under-recognized
complication and adverse prognostic marker
in Multiple Myeloma


Title variants

Languages of publication



Hyperammonemia, a well-known complication
of liver failure causing encephalopathy, has rarely been
reported as a complication of multiple myeloma. We
report four additional cases of hyperammonemia in
patients with treatment refractory multiple myeloma. In
these cases, we found that hyperammonemia remains a
morbid complication of resistant disease without directed
myeloma therapy. Our brief review has reaffirmed that
hyperammonemia is a poor prognostic marker in myeloma
with an undetermined mechanism. This complication’s poor
response to traditional therapies, including rifaximin and
lactulose, prompts our discussion urging early recognition
and myeloma directed therapy. Clinical observations may
support that proteasome inhibitors may be most effective in
the treatment of these patients.







Physical description


10 - 9 - 2015
16 - 5 - 2015
6 - 1 - 2016


  • Hematology/
    Oncology Fellow, Department of Hematology & Oncology, Rutgers
    Robert Wood Johnson Medical School, 125 Paterson Street, Suite
    5200, New Brunswick, NJ 08901,
  • Associate Professor of Medicine, Department of
    Medical Oncology, Rutgers Cancer Institute of New Jersey, 195 Little
    Albany Street, New Brunswick, NJ 08901
  • Assistant Professor of Medicine, Division Chief
    and Program Director Hematology & Oncology, Drexel University
    College of Medicine, 230 North Broad Street, 15th Floor South Tower
    Philadelphia, PA 19102


  • [1] Lora-Tamayo J, Palom X, Sarra J, Gasch O, Isern V, Fernandezde Sevilla A, et al. Multiple myeloma and hyperammonemicencephalopathy: review of 27 cases. Clinical lymphoma &myeloma. 2008;8(6):363-9.[WoS][Crossref]
  • [2] Furer V, Heyd J. Hyperammonemic encephalopathy in multiplemyeloma. The Israel Medical Association journal : IMAJ.2007;9(7):557-9.
  • [3] Benet B, Alexandra JF, Andrieu V, Sedel F, Ajzenberg N,Papo T. Multiple myeloma presenting as hyperammonemicencephalopathy. Journal of the American Geriatrics Society.2010;58(8):1620-2.[Crossref]
  • [4] Howman R, Thakerer A, Pitman M, Ding N, Thompson PA, KhotA, et al. Bortezomib, cyclophosphamide, and dexamethasone:highly effective for rapid reversal of myeloma-associatedhyperammonemic encephalopathy. Leukemia & lymphoma.2010;51(12):2299-302.
  • [5] Pham A, Reagan JL, Castillo JJ. Multiple myeloma-inducedhyperammonemic encephalopathy: an entity associatedwith high in-patient mortality. Leukemia research.2013;37(10):1229-32.[Crossref][WoS]
  • [6] Jones FM, Bokhari SW. Hyperammonemic encephalopathy inmultiple myeloma. Annals of hematology. 2014;93(8):1431-2.[WoS]
  • [7] Ikewaki J, Ogata M, Imamura T, Kohno K, Nakayama T, Kadota J.Development of hyperammonemic encephalopathy in patientswith multiple myeloma may be associated with the appearanceof peripheral blood myeloma cells. Leukemia & lymphoma.2009;50(4):667-9.
  • [8] Ichikawa A, Hashimoto A, Shimizu A, Shizuku J, Abe Y, WakaiS, et al.
  • [A case of acute renal and liver dysfunction withlight chain deposition disease]. Nihon Jinzo Gakkai shi.2007;49(4):459-63.[PubMed]
  • [9] Shah AS, Shetty N, Jaiswal S, Mehta BC. Hyperammonemia: anunusual presenting feature of multiple myeloma. Indian journalof medical sciences. 2005;59(1):24-7.
  • [10] Minauchi K, Fujie T, Matsubara N, Kasahara H, Ogura Y, TamuraM, et al.
  • [Primary plasma cell leukemia (IgD-lambda) withhyperammonemia]. Nihon Naika Gakkai zasshi The Journal ofthe Japanese Society of Internal Medicine. 2004;93(1):139-41.
  • [11] Holahan JR. Hyperammonemia: elevated ammonia levelsin multiple myeloma. The American journal of medicine.2004;116(3):210-1.
  • [12] Kozuka T, Fukuda S, Imai T, Sezaki T.
  • [Clinical significance of amultiple myeloma cell line, derived from a case associated withhyperammonemia]. [PubMed]
  • [Rinsho ketsueki] The Japanese journal ofclinical hematology. 2000;41(11):1220-5.[PubMed]
  • [13] Matsuzaki H, Uchiba M, Yoshimura K, Yoshida M, Akahoshi Y,Okazaki K, et al. Hyperammonemia in multiple myeloma. Actahaematologica. 1990;84(3):130-4.[Crossref][WoS]
  • [14] Martinelli G, Peccatori F, Ullrich B, Ghielmini M, RoggeroE, Goldhirsch A. Clinical manifestation of severe hyperammonaemiain patients with multiple myeloma. Annals ofoncology : official journal of the European Society for MedicalOncology / ESMO. 1997;8(8):811.
  • [15] Frere P, Canivet JL, Gennigens C, Rebeix JP, Fillet G, BeguinY. Hyperammonemia after high-dose chemotherapy andstem cell transplantation. Bone marrow transplantation.2000;26(3):343-5.
  • [16] James JH, Ziparo V, Jeppsson B, Fischer JE. Hyperammonaemia,plasma aminoacid imbalance, and blood-brain aminoacidtransport: a unified theory of portal-systemic encephalopathy.Lancet. 1979;2(8146):772-5.[Crossref]
  • [17] Brucculeri M, Gabbard W, Masson J, Jooma N. Simultaneousdouble hemodialysis for the control of refractory hyperammonemia.The International journal of artificial organs.2013;36(2):135-8.[WoS]
  • [18] Otsuki T, Yamada O, Sakaguchi H, Ichiki T, Kouguchi K, Wada H,et al. In vitro excess ammonia production in human myelomacell lines. Leukemia. 1998;12(7):1149-58.[Crossref]
  • [19] Matsuzaki H, Hata H, Sonoki T, Matsuno F, Kuribayashi N,Yoshida M, et al. Serum amino acid disturbance in multiplemyeloma with hyperammonemia. International journal ofhematology. 1995;61(3):131-7.
  • [20] Kuribayashi N, Matsuzaki H, Hata H, Yoshida M, Sonoki T,Nagasaki A, et al. Multiple myeloma associated with serumamino acid disturbance and high output cardiac failure.American journal of hematology. 1998;57(1):77-81.
  • [21] Martin SK, Diamond P, Gronthos S, Peet DJ, Zannettino AC. Theemerging role of hypoxia, HIF-1 and HIF-2 in multiple myeloma.Leukemia. 2011;25(10):1533-42.[WoS]
  • [22] Watson AJ, Chambers T, Karp JE, Risch VR, Walker WG, BrusilowSW. Transient idiopathic hyperammonaemia in adults. Lancet.1985;2(8467):1271-4.[Crossref]

Document Type

Publication order reference


YADDA identifier

JavaScript is turned off in your web browser. Turn it on to take full advantage of this site, then refresh the page.