title: Elevated vascular endothelial growth factor pretreatment levels are correlated with the tumor burden in Hodgkin lymphoma and continue to be elevated in prolonged complete remission.
abstract: BACKGROUND
  Vascular endothelial growth factor (VEGF) has been described as an essential cytokine in the regulation of angiogenesis. Its elevation in peripheral blood or bone marrow has been associated with an unfavorable outcome in different hematologic neoplasms. Hodgkin lymphoma represents approximately one fifth of all lymphomas, and the roles of angiogenesis and VEGF in Hodgkin lymphoma have not been well defined at present.
  
  
  METHODS
  Vascular endothelial growth factor serum levels were determined by enzyme-linked immunosorbent assay in 54 newly diagnosed patients, 26 patients in prolonged complete remission (CR), and 54 healthy controls. Vascular endothelial growth factor levels were compared among the different populations and correlated with prognostic factors and disease evolution.
  
  
  RESULTS
  Newly diagnosed patients showed an increase in VEGF level compared with the CR subgroup (549 pg/mL vs. 327.5 pg/mL; P = 0.023) and with healthy controls (549 pg/mL vs. 140 pg/mL; P < 0.001). Patients in CR also showed an elevated VEGF with respect to healthy controls (327.5 pg/mL vs. 140 pg/mL; P = 0.01). Elevated VEGF was also statistically correlated with newly diagnosed patients with a greater tumor burden (594.5 pg/mL vs. 391 pg/mL; P = 0.009), with > or = 4 involved areas (608 pg/mL vs. 507 pg/mL; P = 0.036), and with an Eastern Cooperative Oncology Group performance status of > or = 1 (812 pg/mL vs. 447pg/mL; P = 0.005). Vascular endothelial growth factor was also elevated in advanced-stage disease, in patients with B symptoms, and poor-risk groups, but none of them became statistically significant.
  
  
  CONCLUSIONS
  Pathologic angiogenesis is an activated pathway in Hodgkin lymphoma and participates in Hodgkin lymphoma progression. This has been shown by an elevated VEGF level in patients: before first treatment, with greater tumor burden, and with a higher number of involved areas. Furthermore, VEGF continues to be elevated in patients with Hodgkin lymphoma after prolonged CR.
authors.affiliation: Oncology Department, Hospital Clinico Universitario, Malaga, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rueda
authors.forename: David
authors.initials: D
authors.lastname: Olmos
authors.forename: Vicente
authors.initials: V
authors.lastname: Villareal
authors.forename: Esperanza
authors.initials: E
authors.lastname: Torres
authors.forename: Bella Isabel
authors.initials: BI
authors.lastname: Pajares
authors.forename: Emilio
authors.initials: E
authors.lastname: Alba
mesh_terms: D018450:Disease Progression; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006689:Hodgkin Disease / Q000097:blood* / Q000473:pathology*; D006801:Humans; D008297:Male; D009389:Neovascularization, Pathologic / Q000097:blood*; D018709:Statistics, Nonparametric; D047368:Tumor Burden; D042461:Vascular Endothelial Growth Factor A / Q000097:blood*
chemical_list: D042461:Vascular Endothelial Growth Factor A