Amylase: A disease activity index in multiple myeloma?

Abstract

This study reports a case of a patient with lambda-light chain multiple myeloma who developed a high hyperamylasaemia of the salivary type during the disease and soon afterwards died. Ectopic production of amylase by myeloma cells has been described in a few cases and demonstrated by tissue culture and immunohistochemical techniques. The common characteristics of these cases were: salivary amylase isoenzyme increase, high tumor mass, extensive extra-medullary spread, extensive bone destruction and poor prognosis. In patients with amylase-producing multiple myeloma, the onset of hyperamylasaemia heralds a rapid disease progression; therefore, in these patients, a simple test such as serum amylase may represent a reliable disease activity index and provide an additional prognostic information.

Paraneoplastic Hyperamylasaemia in Association with Multiple Myeloma

“…The association between malignancy and hyperamylasaemia was first described in a patient with lung cancer in 1951 [3]. Subsequently, an increased ectopic production of amylase has been reported in both epithelial and non-epithelial tumors [4,5,6]. The present report describes a fatal case of a patient presenting marked hyperamylasaemia which appeared at diagnosis and with the relapse of an underlying multiple myeloma.…”

“…Occasional reports, mostly from Japan, have documented this rare complication in a few cases of multiple myeloma with extramedullary spread [4,5,6,7,8,9,10,11,12,13,14]. Currently, pathogenesis of the hyperamylasaemia-associated myeloma is not well understood [4, 5].…”

“…Currently, pathogenesis of the hyperamylasaemia-associated myeloma is not well understood [4, 5]. The proposed mechanisms [5] are inflammatory conditions of the salivary glands and the pancreas [12, 15], macroamylasaemia [2], renal failure [16], and ectopic production of amylase by plasma cells [4,5,6,7,8,9,10,11,12,13]. …”

“…Occasional reports, mostly from Japan, have documented this rare complication in a few cases of multiple myeloma with extramedullary spread [4,5,6,7,8,9,10,11,12,13,14]. Currently, pathogenesis of the hyperamylasaemia-associated myeloma is not well understood [4, 5]. The proposed mechanisms [5] are inflammatory conditions of the salivary glands and the pancreas [12, 15], macroamylasaemia [2], renal failure [16], and ectopic production of amylase by plasma cells [4,5,6,7,8,9,10,11,12,13].…”

Hyperamylasaemia: don’t forget undiagnosed carcinoma

“…It has been suggested that serum amylase activity may be a prognostic index of multiple myeloma disease progression. 11 Ovarian carcinomas 12,13 are also associated with hyperamylasaemia as are some lung tumours. Amylase-producing tumours of the lung are rare and may comprise in total only 1-3% of all lung carcinomas and, in these cases, the salivary amylase isotype is generally found.…”