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. 2023 Mar 1;62(5):775-778.
doi: 10.2169/internalmedicine.0010-22. Epub 2022 Jul 22.

Multiple Myeloma with Hyperammonemia Treated with Novel Agents: A Case Series of Three Patients

Hajime Nakamura  1 , Kohichi Takada  1 , Kazuyuki Murase  1 , Hiroshi Ikeda  2 , Satoshi Iyama  2 , Tatsuo Manabe  3 , Masayoshi Kobune  2
Affiliations

Multiple Myeloma with Hyperammonemia Treated with Novel Agents: A Case Series of Three Patients

Hajime Nakamura et al. Intern Med. .

Abstract

Multiple myeloma (MM) is a cancer characterized by the expansion of plasma cells in the bone marrow. Survival times of patients with MM have increased due to the development of novel therapeutic agents. We herein highlight three MM cases that had a poor prognosis despite treatment with novel therapeutic agents. Of note, all patients presented with hyperammonemia that led to a consciousness disorder. The outcome for patients with MM showing high levels of serum ammonia continues to be poor, even with the use of novel therapies. For such patients showing a consciousness disorder, hyperammonemia should be considered as a possible cause.

Keywords: hyperammonemia; multiple myeloma.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Electroencephalogram findings for Case 1. Electroencephalography revealed triphasic waves that implied metabolic abnormalities, such as hyperammonemia.
Figure 2.
Figure 2.
Clinical courses for the three patients. a: Case 1, b: Case 2, c: Case 3. BCAA: branched-chain amino acid, EPd: elotuzumab-pomalidomide-dexamethasone, ERd: elotuzumab-lenalidomide-dexamethasone, Kd: carfilzomib-dexamethasone, KRd: carfilzomib-lenalidomide-dexamethasone
See this image and copyright information in PMC

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