title: High serum lactate dehydrogenase level as a marker for drug resistance and short survival in multiple myeloma.
abstract: OBJECTIVE
  To evaluate serum lactate dehydrogenase (LDH) as a prognostic factor in previously untreated patients with multiple myeloma.
  
  
  METHODS
  Study of 391 consecutive patients with uniformly treated multiple myeloma, followed until death in 63% of patients.
  
  
  METHODS
  Tertiary, referral cancer center.
  
  
  METHODS
  A total of 391 consecutive, previously untreated, symptomatic patients with various stages of multiple myeloma.
  
  
  METHODS
  Various chemotherapy regimens that included doxorubicin or glucocorticoids, or both, with a consistent response rate (53%).
  
  
  METHODS
  Outcomes included clinical response based on a 75% reduction of calculated tumor load and survival time from treatment. Univariate and multivariate analyses were used.
  
  
  RESULTS
  Eleven percent of patients showed a high serum LDH level of more than 5.0 mukat/L (300 U/L). An elevated LDH level was seen more frequently with a rise in the tumor load; an increased level was present in 26% of patients with high tumor mass. A high LDH level was associated with plasma cell leukemia or lymphoma-like clinical features (43%) and with plasma cell hypodiploidy (17%). Only 20% of patients with elevated LDH levels responded to chemotherapy compared with a response rate of 57% for patients with low levels of LDH. Using multivariate analysis, LDH was a significant independent predictor of response (P = 0.001), with an odds ratio of 0.25 (95% Cl, 0.11 to 0.57). A high LDH level was associated with a short median survival (9 months) and showed the highest relative risk (2.63; Cl, 1.75 to 3.95; P = 0.001).
  
  
  CONCLUSIONS
  Elevation of the LDH level suggests the presence of occult extraosseous disease and high tumor mass. The LDH level is a predictor of a poor prognosis in selected patients who should be considered for early intensive treatment.
authors.affiliation: University of Texas M. D. Anderson Cancer Center, Houston.
authors.forename: M A
authors.initials: MA
authors.lastname: Dimopoulos
authors.forename: B
authors.initials: B
authors.lastname: Barlogie
authors.forename: T L
authors.initials: TL
authors.lastname: Smith
authors.forename: R
authors.initials: R
authors.lastname: Alexanian
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015415:Biomarkers; D004351:Drug Resistance / Q000235:genetics; D006801:Humans; D007621:Karyotyping; D007770:L-Lactate Dehydrogenase / Q000097:blood*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000201:enzymology* / Q000401:mortality; D011003:Ploidies; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D015415:Biomarkers; D007770:L-Lactate Dehydrogenase