Serum lactate dehydrogenase level as a prognostic factor in Hodgkin's disease

Abstract

Summary The efficacy of currently available treatments for Hodgkin's disease (HD) has led to a substantial modification in the prognosis of this disease; nevertheless there is still a group of patients that cannot be cured with conventional treatments and who will be candidates for alternative therapy. In the present work we analysed the prognostic influence of the most relevant clinico-biological characteristics of HD in a consecutive series of 137 patients diagnosed and treated in a single institution. Univariate analyses identified six variables with significant prognostic influence, both on achieving complete remission (CR) and overall survival (OS); LDH >320 U ml-', age >45 years, stages IIB, III and IV, extranodal involvement, alkaline phosphatase >19OUIdl and ESR >40mmh. In addition, Hb<12.5grdl-' and abdominal disease were statistically relevant for CR while a poor performance score (ECOG ) 2) affected a lower survival. In the multivariate analysis only LDH, age and the clinical stage retained a significant prognostic influence for achieving CR, while the two first factors above, together with performance status were the variables with independent prognostic value with respect to OS. Moreover, only LDH >320Uml-' had prognostic influence in the probability of relapse and disease free survival (DFS), both in the univariate and multivariate analyses.According to the three independent factors obtained in the multivariate analysis for CR (LDH, age and stage) a predictive model was established that allows the stratification of patients into two prognostic groups: one with poor prognosis that includes patients with the three adverse prognostic factors, or two if one of them was elevated LDH, and the other with good prognosis that includes the remaining patients. This model was also able to separate two independent groups of patients with respect to OS and to DFS. In conclusion, the present study shows that LDH is one of the most important prognostic factors in HD.

Serum macrophage colony-stimulating factor (M-CSF) in patients with Hodgkin lymphoma

“…Still, we found circulating M-CSF to correlate with serum VEGF and bFGF levels in HL patients. Interestingly, there was no correlation between the serum levels of M-CSF and LDH, the unspecific parameter related to the tumour burden, the degree of cell destruction and an important prognostic factor in many cancers, including HL [30,31]. The absence of parallel changes of the two parameters in the sera of HL patients might suggest that M-CSF levels are not related to cancer cell activity, as LDH is, but might reflect hypoxia-induced changes in cancer cells.…”

Prognostic analysis and a new risk model for Hodgkin lymphoma in Japan

“…Sex might be associated with the metabolism of anticancer drugs [21]. Elevated serum LDH was previously reported to be prognostically unfavorable in advanced HL [22,23] and is also one of the most important factors in the international prognostic index of non-HL [24]. Therefore, elevated serum LDH might reflect the total status of HL, including both constitutional and disease-related elements.…”

Lactate dehydrogenase 5: An old friend and a new hope in the war on cancer

“…Serum LDH is commonly increased in patients with hematopoietic malignancies, such as Hodgkin's lymphoma (HL), non-Hodgkin's lymphoma (NHL) or multiple myeloma. LDH is one of the risk factors included in the International Prognostic Index (IPI) and it is considered a strong predictor of survival of patients with aggressive lymphoid cancers [34][35][36][37][38]. As shown, serum LDH level inversely correlated with the survival of patients with small cell lung cancer (SCLC) and allowed the selection of very high-risk patients.…”