High serum lactate dehydrogenase adds prognostic value to the international myeloma staging system even in the era of novel agents

Terpos, Evangelos; Katodritou, Eirini; Ρούσσου, Μαρία; Pouli, Anastasia; Michalis, Eurydiki; Delimpasi, Sosana; Parcharidou, Agapi; Kartasis, Zafiris; Zomas, Athanasios; Symeonidis, Argiris; Viniou, Nora‐Athina; Anagnostopoulos, Nikolaos; Economopoulos, Theofanis; Zervas, Konstantinos; Dimopoulos, Meletios Α.

doi:10.1111/j.1600-0609.2010.01466.x

Cited by 123 publications

(81 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The median OS of high and normal LDH groups among 598 patients who received novel agents was 21 vs 51 months, respectively (Po0.001). 31 These data along with our results in the relapsed/refractory setting support the notion that serum LDH should be included in future phase 2/3 studies to evaluate its impact on the management of myeloma patients, as LDH prognostic value appears to be as important as that of more expensive and not so easily available parameters.…”

Section: Discussionsupporting

confidence: 78%

See 1 more Smart Citation

Treatment of patients with relapsed/refractory multiple myeloma with lenalidomide and dexamethasone with or without bortezomib: prospective evaluation of the impact of cytogenetic abnormalities and of previous therapies

Dimopoulos

Christoulas²,

Migkou³

et al. 2010

Leukemia

108

106

View full text Add to dashboard Cite

We prospectively studied the impact of several cytogenetic abnormalities (CAs) in patients with relapsed/refractory myeloma who received lenalidomide and dexamethasone (RD) with or without the addition of bortezomib (V). On the basis of the presence of previous neuropathy, 50 patients were treated with RD and 49, without preexisting neuropathy, with VRD. The overall response rate was 63%, similar for RD and VRD. Poor risk cytogenetics were associated with lower response rates in RD (P ¼ 0.01), but not in VRD (P ¼ 0.219). The median progression-free survival (PFS) was similar for RD (9 months) and VRD (7 months). The median overall survival (OS) for all patients was 16 months, with no differences between RD or VRD regimens. Poor risk cytogenetics, especially del17p, resistance to previous thalidomide, elevated lactate dehydrogenase (LDH) and presence of extramedullary disease were associated with inferior response to therapy and shorter PFS and OS. The impact of other CAs on OS was more pronounced in RD. In conclusion, the presence of CAs is an important adverse prognostic factor for patients with relapsed/refractory myeloma, but resistance to previous thalidomide, elevated LDH and presence of extramedullary disease remain of major prognostic importance. The outcome of patients with del17p remains extremely poor even with VRD combination.

show abstract

Section: Discussionsupporting

confidence: 78%

“…This result has also been described in studies that included patients who were treated with immunomodulatory drugs or bortezomib, 31,34 and supports the adverse prognostic impact of thrombocytopenia on survival in myeloma.…”

Section: Discussionsupporting

confidence: 78%

Treatment of patients with relapsed/refractory multiple myeloma with lenalidomide and dexamethasone with or without bortezomib: prospective evaluation of the impact of cytogenetic abnormalities and of previous therapies

Dimopoulos

Christoulas²,

Migkou³

et al. 2010

Leukemia

108

106

View full text Add to dashboard Cite

show abstract

“…In other recent studies, serum LDH levels were the main prognostic factor for colorectal cancer in a survival prognostic model (38). Moreover, the addition of LDH to the International Myeloma Staging Model was found to improve prognostic value (39). Taken together, these various analyses support the potential prognostic value of baseline LDH levels across several tumor types.…”

Section: Discussionmentioning

confidence: 56%

Serum Lactate Dehydrogenase Is Prognostic for Survival in Patients with Bone Metastases from Breast Cancer: A Retrospective Analysis in Bisphosphonate-Treated Patients

Brown

Cook

Lipton

et al. 2012

Clinical Cancer Research

View full text Add to dashboard Cite

Purpose: Survival is highly variable in women with bone metastases from breast cancer and prognostic factors are needed. We analyzed data from a phase III trial comparing zoledronic acid (ZOL) with pamidronate in patients with breast cancer and bone metastases to identify variables prognostic for overall survival.Experimental Design: Patients who received ZOL (n ¼ 435) with bone marker assessments and complete baseline data were included. Relative risks (RR) of death over 24 months were assessed using a stratified Cox regression analysis. A reduced model was generated using stepwise backward elimination until only significant (P < 0.05) variables remained.Results: Only 5 of 19 variables analyzed remained significantly prognostic for survival in the reduced multivariate model. These included age more than 50 years (RR 1.78-2.53, P 0.01 for each decade >50 versus 50); Functional Assessment of Cancer Therapy-General (FACT-G) score less than 65 units (P < 0.05 vs. !75 units); impaired (PS ! 1) versus fully active (PS ¼ 0) Eastern Cooperative Oncology Group (ECOG) performance status (RR 1.74, P < 0.01); prior versus no prior chemotherapy (RR 1.97; P < 0.01), and lactate dehydrogenase (LDH) levels. Lactate dehydrogenase ! upper limit of normal (ULN) but < 2 Â ULN correlated with a two-fold increased risk of death, and LDH > 2 Â ULN correlated with a six-fold increased risk of death versus LDH < ULN (P < 0.0001 for both). Baseline bone marker levels were not significantly correlated with survival after adjustment for other significant covariates.Conclusions: This retrospective analysis shows that LDH levels correlate strongly with survival in patients with bone metastases from breast cancer and confirms the relevance of previously described prognostic factors.

show abstract

“…Within the current cohort of patients, 31.7% had elevated LDH (ie, levels above the upper limit of normal), which is higher than what has been previously reported. For example, in a study of 996 consecutive MM patients, 11% of patients had elevated serum LDH levels17; similarly, in a study of 203 patients with symptomatic MM, 7% had elevated LDH 18. The higher rate of elevated LDH reported here may suggest shorter OS for our cohort of patients, compared with the original dataset from which the R‐ISS system was developed (where only 13% of evaluable patients had elevated LDH) 1.…”

Section: Discussionmentioning

confidence: 58%

Validation of multiple myeloma risk stratification indices in routine clinical practice: Analysis of data from the Czech Myeloma Group Registry of Monoclonal Gammopathies

et al. 2018

View full text Add to dashboard Cite

This study used data from the Czech Myeloma Group Registry of Monoclonal Gammopathies to validate the International Myeloma Working Group (IMWG) and revised International Staging System (R‐ISS) indices for risk stratification in patients with multiple myeloma (MM) in clinical practice. Patients were included if they had symptomatic MM, complete data allowing R‐ISS and IMWG staging (including cytogenetic information regarding t(4;14), t(14;16), and del(17p)), and key parameters for treatment evaluation. Median overall survival (OS) in included patients (n = 550) was 47.7 (95% CI: 39.5‐55.9) and 46.2 (95% CI: 38.9‐53.5) months from diagnosis and initiation of first‐line therapy, respectively. Patients categorized as higher vs lower risk had reduced survival; median OS from diagnosis was 35.4 (95% CI: 30.5‐40.3) vs 58.3 (95% CI: 53.8‐62.9) months in high‐risk vs other patients (IMWG; P = .001) and 34.1 (95% CI: 30.2‐38.0) vs 47.2 (95% CI: 43.4‐51.0) months in Stage III vs Stage II patients (R‐ISS; P < .001). In conclusion, IMWG and R‐ISS risk stratification indices are applicable to patients with MM in a real‐world setting.

show abstract

High serum lactate dehydrogenase adds prognostic value to the international myeloma staging system even in the era of novel agents

Abstract: Lactate dehydrogenase is a readily available and inexpensive variable, which has a major impact on the survival of myeloma patients even when they belong to a low or intermediate ISS subgroup and even when they receive novel agent-based therapies.

Cited by 123 publications

References 17 publications

Treatment of patients with relapsed/refractory multiple myeloma with lenalidomide and dexamethasone with or without bortezomib: prospective evaluation of the impact of cytogenetic abnormalities and of previous therapies

Treatment of patients with relapsed/refractory multiple myeloma with lenalidomide and dexamethasone with or without bortezomib: prospective evaluation of the impact of cytogenetic abnormalities and of previous therapies

Serum Lactate Dehydrogenase Is Prognostic for Survival in Patients with Bone Metastases from Breast Cancer: A Retrospective Analysis in Bisphosphonate-Treated Patients

Validation of multiple myeloma risk stratification indices in routine clinical practice: Analysis of data from the Czech Myeloma Group Registry of Monoclonal Gammopathies

Contact Info

Product

Resources

About