Department of Medical Oncology, Amrita Institute of Medical Science, Kochi, Kerala, India.
Department of Biochemistry, Amrita Institute of Medical Science, Kochi, Kerala, India.
J Cancer Res Ther. 2023 Jul-Sep;19(5):1231-1235. doi: 10.4103/jcrt.jcrt_2143_21.
Ectopic production of amylase by tumor cells is known since 1951. Elevated amylase in multiple myeloma (MM) was first described in 1988. It has been postulated that translocation of chromosome 1, where amylase gene is situated, is responsible for ectopic production from the malignant plasma cells. Anecdotal reports have shown hyperamylasemia in MM to be associated with extensive bone disease, rapid progression, and shorter survival. Serum amylase estimation is a ubiquitous test. This prospective study was conducted to ascertain the degree of elevated amylase, its clinical utility, and implications in MM patients.
In an 18-month period, all consenting patients with newly diagnosed or relapsed MM were tested for serum amylase levels. The study excluded patients with elevated lipase, abnormal creatinine clearance, and evidence of intestinal obstruction or perforation. Patients with amylase value >100 U/L were designated to have "elevated amylase level" for the purpose of this study.
We enrolled 58 patients with MM, of which 29.3% (n = 17) were found to have elevated serum amylase levels. The median age of patients with elevated amylase was 65 years. The male-to-female ratio was 1.9:1. There was no statistical association between age, gender, type of heavy chain class, light chain, or high-risk cytogenetics. Among patients with the International Staging System (ISS), Stages I, II, and III, 20.8% (n = 5), 31.3% (n = 5), and 41.2% (n = 7) were noted to have elevated amylase levels. A statistically significant association was noted between the presence of extramedullary disease (EMD) and elevated amylase level (P = 0.028). Higher mortality (29.4% versus 17%) and shorter mean survival of (30.2 ± 3.3 months versus 51.7 + 4.9 months) were recorded in patients with elevated amylase levels in comparison to those with normal levels.
Elevated serum amylase level in MM is indicative of advanced ISS stage, the presence of EMD, higher risk of mortality, and shorter survival. Serum amylase can be used as a cost-effective tool in myeloma management.
自 1951 年以来，人们就已经知道肿瘤细胞会异位产生淀粉酶。1988 年首次描述了多发性骨髓瘤（MM）中淀粉酶升高。有人假设，染色体 1 易位，其中淀粉酶基因所在，负责恶性浆细胞的异位产生。一些传闻报告表明，MM 中的高淀粉酶血症与广泛的骨骼疾病、快速进展和更短的生存有关。血清淀粉酶估计是一种普遍的测试。进行这项前瞻性研究是为了确定升高的淀粉酶程度、其临床实用性以及对 MM 患者的影响。
在 18 个月的时间里，所有新诊断或复发的 MM 患者均接受了血清淀粉酶水平检测。该研究排除了脂酶升高、肌酐清除率异常以及有肠梗阻或穿孔证据的患者。淀粉酶值>100U/L 的患者被指定为该研究的“淀粉酶水平升高”。
我们纳入了 58 例 MM 患者，其中 29.3%（n=17）发现血清淀粉酶水平升高。淀粉酶升高患者的中位年龄为 65 岁。男女比例为 1.9:1。年龄、性别、重链类别、轻链或高危细胞遗传学之间没有统计学关联。在国际分期系统（ISS）中，I 期、II 期和 III 期患者分别有 20.8%（n=5）、31.3%（n=5）和 41.2%（n=7）出现淀粉酶升高。存在骨髓外疾病（EMD）与淀粉酶水平升高之间存在统计学显著关联（P=0.028）。与淀粉酶水平正常的患者相比，淀粉酶水平升高的患者死亡率更高（29.4%对 17%），平均生存时间更短（30.2+3.3 个月对 51.7+4.9 个月）。
MM 中血清淀粉酶水平升高提示 ISS 分期较晚、存在 EMD、死亡率较高和生存时间较短。血清淀粉酶可以作为骨髓瘤管理的一种具有成本效益的工具。
