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High Serum Lactate Dehydrogenase Level as a Marker for Drug Resistance and Short Survival in Multiple Myeloma

Meletios A. Dimopoulos, MD; Bart Barlogie, MD; Terry L. Smith, MS; and Raymond Alexanian, MD
[+] Article, Author, and Disclosure Information

Grant Support: By grants CA-16672, CA-28771 and CA-37161 from the National Cancer Institute and a grant from the Hompe myeloma research fund.

Requests for Reprints: Raymond Alexanian, MD, Box 1, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030.

Current Author Addresses: Drs. Dimopoulos and Alexanian and Mrs. Smith: University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030.

Dr. Barlogie: University of Arkansas Medical School, 4301 West Markham Slot 508, Little Rock, AR 72205.

©1991 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1991;115(12):931-935. doi:10.7326/0003-4819-115-12-931
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Objective: To evaluate serum lactate dehydrogenase (LDH) as a prognostic factor in previously untreated patients with multiple myeloma.

Design: Study of 391 consecutive patients with uniformly treated multiple myeloma, followed until death in 63% of patients.

Setting: Tertiary, referral cancer center.

Patients: A total of 391 consecutive, previously untreated, symptomatic patients with various stages of multiple myeloma.

Intervention: Various chemotherapy regimens that included doxorubicin or glucocorticoids, or both, with a consistent response rate (53%).

Measurements: Outcomes included clinical response based on a 75% reduction of calculated tumor load and survival time from treatment. Univariate and multivariate analyses were used.

Main Results: Eleven percent of patients showed a high serum LDH level of more than 5.0 µkat/L (300 U/L). An elevated LDH level was seen more frequently with a rise in the tumor load; an increased level was present in 26% of patients with high tumor mass. A high LDH level was associated with plasma cell leukemia or lymphoma-like clinical features (43%) and with plasma cell hypodiploidy (17%). Only 20% of patients with elevated LDH levels responded to chemotherapy compared with a response rate of 57% for patients with low levels of LDH. Using multivariate analysis, LDH was a significant independent predictor of response (P = 0.001), with an odds ratio of 0.25 (95% Cl, 0.11 to 0.57). A high LDH level was associated with a short median survival (9 months) and showed the highest relative risk (2.63; Cl, 1.75 to 3.95; P = 0.001).

Conclusions: Elevation of the LDH level suggests the presence of occult extraosseous disease and high tumor mass. The LDH level is a predictor of a poor prognosis in selected patients who should be considered for early intensive treatment.





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