title: Elevated lactate dehydrogenase levels detected during routine follow-up do not predict relapse in patients with diffuse large B-cell lymphoma who achieve complete remission after primary treatment with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone-like immunochemotherapy.
abstract: A significant minority of patients with diffuse large B-cell lymphoma (DLBCL) who enter a complete remission following standard first-line immunochemotherapy will relapse. A primary aim of follow-up is to detect early relapse, with the hope of improving outcome following salvage chemotherapy. It is often routine to measure lactate dehydrogenase (LDH) as part of follow-up; however, the evidence for the utility of LDH as a predictor for relapse is scant. A retrospective analysis of the LDH results recorded during the follow-up of 102 patients with DLBCL who achieved a CR following treatment was undertaken in order to determine the utility of LDH as a predictor for relapse (median follow-up 24 months). Despite the fact that the sensitivity of LDH was 69% (95% confidence interval [CI] 39-91), the positive predictive value (PPV) of a raised LDH was only 9/63, 14% (95% CI 6.7-25). Furthermore, in eight of the nine patients who had a raised LDH prior to relapse, symptoms suggestive of relapse were documented simultaneously. As the PPV of a raised LDH is so low and because a raised LDH may cause unnecessary worry, leading to unnecessary radiological investigations, routine evaluation of LDH in patients with DLBCL who achieve CR and who are asymptomatic is not recommended.
authors.affiliation: Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, Middlesex, UK. dima@doctors.org.uk
authors.forename: Dima
authors.initials: D
authors.lastname: El-Sharkawi
authors.forename: Suprotim
authors.initials: S
authors.lastname: Basu
authors.forename: Charina
authors.initials: C
authors.lastname: Ocampo
authors.forename: Wendi
authors.initials: W
authors.lastname: Qian
authors.forename: Shirley
authors.initials: S
authors.lastname: D'Sa
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Hoskin
authors.forename: Kirit M
authors.initials: KM
authors.lastname: Ardeshna
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000097:blood* / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D011379:Prognosis; D012008:Recurrence; D012074:Remission Induction; D000069283:Rituximab; D014750:Vincristine / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D007770:L-Lactate Dehydrogenase; D011241:Prednisone