High serum levels of lactic dehydrogenase identify a high-grade lymphoma-like myeloma.
Although conferring a grave prognosis in patients with malignant lymphoma, high levels of serum lactic dehydrogenase (LDH) are usually not seen in patients with multiple myeloma, a more indolent tumor composed mainly of B cells in their terminal stage of differentiation. Thus, only 2 of 118 patients in earlier phases of myeloma showed marked LDH elevations to more than 500 U/L, whereas such abnormalities were present in 12 of 64 patients with advanced disease progressing despite treatment with vincristine, doxorubicin (Adriamycin), dexamethasone (VAD) (median LDH level, 700 U/L). High LDH levels were associated with high serum levels of beta-2-microglobulin, hypercalcemia, extraosseous disease features, a short preceding clinical course as well as a short subsequent survival time. A poor prognosis was also noted in patients with lower LDH in whom marked increments were induced by high-dose chemotherapy; thus, LDH elevations to greater than 300 U/L present before or found after high-dose cytotoxic therapy were observed in about 50% of patients with VAD-resistant myeloma and define a new clinical entity with features of extraosseous disease and an unusually aggressive course ("high-grade myeloma"). The shorter survival of newly diagnosed patients with high-normal compared with those with low-normal LDH levels (less than 200 U/L), regardless of tumor mass, suggests the presence in some patients of a tumor subpopulation with high LDH production that escapes growth control with standard treatment. Staging of multiple myeloma should therefore include measurements of serum LDH levels in addition to beta-2-microglobulin analysis and tumor mass estimation.
Barlogie
B
B
M.D. Anderson Hospital, Houston, Texas.
Smallwood
L
L
Smith
T
T
Alexanian
R
R
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003907:Dexamethasone / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood*; D008558:Melphalan / Q000627:therapeutic use; D009101:Multiple Myeloma / Q000201:enzymology* / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D014750:Vincristine / Q000008:administration & dosage; D014916:Whole-Body Irradiation; D001613:beta 2-Microglobulin / Q000378:metabolism
D001613:beta 2-Microglobulin; D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D007770:L-Lactate Dehydrogenase; D008558:Melphalan