Fahrmann JF, Wasylishen AR, Pieterman CRC, et al. - Because duodenopancreatic neuroendocrine tumors (dpNETs) are common in patients with Multiple Endocrine Neoplasia Type 1 (MEN1), and metastatic dpNET is the leading cause of disease-related mortality, experts aspired to explore whether MEN1-dpNET-related disease progression is correlated with elevated levels of circulating polyamines. Plasma polyamine levels were measured using mass spectrometry in 84 patients with MEN1 (20 with distant metastatic dpNETs (cases) and 64 with either indolent dpNETs or no dpNETs (controls)) as part of an international collaboration between MD Anderson Cancer Center, the National Institutes of Health, and the University Medical Center Utrecht. In an initial set of plasmas from the three participating centers, a 3-marker plasma polyamine signature (3MP: n-acetylputrescine, acetylspermidine, and diacetylspermidine) distinguished patients with metastatic dpNETs from controls. The findings provide a foundation for future testing of blood-based polyamines as a potential means of monitoring patients with MEN1 for the presence or development of aggressive disease.