title: The utility of lactate dehydrogenase in the follow up of patients with diffuse large B-cell lymphoma.
abstract: BACKGROUND
  Serum lactate dehydrogenase is a non-specific marker for lymphoma whose prognostic significance is well established for both indolent and aggressive lymphomas at the time of diagnosis. The performance characteristics of this enzyme in predicting relapse in patients with diffuse large B-cell lymphoma has not been well studied.
  
  
  METHODS
  This study compared serum lactate dehydrogenase levels in 27 patients with diffuse large B-cell lymphoma who relapsed after sustaining a complete response versus 87 patients who did not relapse. For relapsed patients, the serum lactate dehydrogenase level at relapse was compared with the level three months before (considered baseline). For non-relapsed patients, the last two levels during follow-up were compared. For statistical analysis the T-test was used to compare differences in mean values between groups. The sensitivity, specificity, positive and negative predictive values for serum lactate dehydrogenase in detecting relapse compared to confirmatory imaging were calculated.
  
  
  RESULTS
  At relapse, only 33% patients had increases in serum lactate dehydrogenase above the upper limit of normal. The mean increase was 1.2-fold above the upper limit of normal for relapsed vs. 0.83 for those who did not relapse (p-value = 0.59). The mean increase in serum lactate dehydrogenase, from baseline, was 1.1-fold in non-relapsed vs. 1.3 in relapsed patients (p-value = 0.3). The likelihood ratio of relapse was 4.65 for patients who had 1.5-fold increases in serum lactate dehydrogenase above baseline (p-value = 0.03). The sensitivity, specificity, positive and negative predictive values of 1.5-fold increases for detecting relapse, compared to clinical and imaging findings were 0.18, 0.95, 0.55, and 0.79, respectively.
  
  
  CONCLUSIONS
  A 1.5-fold increase in serum lactate dehydrogenase, over a period of 3 months, is associated with increased likelihood of relapse from diffuse large B-cell lymphoma.
authors.affiliation: University Hospitals Case Medical Center / Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Basem Magdy
authors.initials: BM
authors.lastname: William
authors.forename: Navneeth Rao
authors.initials: NR
authors.lastname: Bongu
authors.forename: Martin
authors.initials: M
authors.lastname: Bast
authors.forename: Robert Gregory
authors.initials: RG
authors.lastname: Bociek
authors.forename: Philip Jay
authors.initials: PJ
authors.lastname: Bierman
authors.forename: Julie Marie
authors.initials: JM
authors.lastname: Vose
authors.forename: James Olen
authors.initials: JO
authors.lastname: Armitage
keywords: Antineoplastic agents; Follow-up studies; L-Lactate dehydrogenase; Lymphoma, large B-Cell, diffuse; Lymphoma, non-Hodgkin
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