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High Serum Levels of Lactic Dehydrogenase Identify a High-Grade Lymphoma-like Myeloma

Bart Barlogie, MD; Leslie Smallwood; Terry Smith, MS; and Raymond Alexanian, MD
[+] Article, Author, and Disclosure Information

Grant Support: Supported in part by grants CA37161 and CA28771 from the National Cancer Institute.

Requests for Reprints: Bart Barlogie, MD, Department of Hematology, M.D. Anderson Hospital, 1515 Holcombe Boulevard, Box 30, Houston, TX 77030.

Current Author Addresses: Drs. Barlogie and Alexanian, and Ms. Smallwood and Ms. Smith: M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Box 30, Houston, TX 77030.

©1989 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1989;110(7):521-525. doi:10.7326/0003-4819-110-7-521
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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 ( < 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.





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