Prognostic value of serum lactate dehydrogenase in symptomatic multiple myeloma.

8093 Background: In patients with symptomatic multiple myeloma, the clinical features, responses to treatment, and survival times vary. Well established predictors of survival include the International Staging System (ISS), cytogenetic abnormalities, and response to therapy. Long recognized has been the association of high serum lactate dehydrogenase (LDH) with advanced disease and shorter survival. We focused here on the impact of high LDH on staging and prognosis in order to guide the role of recent advances in therapy. Methods: We evaluated 1,247 patients with newly diagnosed, symptomatic myeloma from 10/74 to 7/11. Our goal was to determine the prognostic value of high LDH (>300 IU/L) in relation to ISS stage. We also compared the frequencies of anemia, hypercalcemia, and response to therapy in patients with high LDH with those of patients with Stage III disease and normal LDH values. Results: All 1,139 patients with normal LDH lived significantly longer than the 108 patients with elevated values (47 vs. 16 months, p <.01). LDH was elevated in 9% of all patients, but in 2%, 6%, and 18% of patients with ISS-I, II, and III disease, respectively. Their survival times were also significantly shorter than those of comparable patients in each stage with normal LDH (table). Among the 108 patients with high LDH, the frequencies of hemoglobin <8.5 g/dl (54 vs. 41%, p=.03), and serum calcium>11.5 mg/dl (41 vs. 27%, p<.01) were significantly higher than those of 292 patients with Stage III disease and normal LDH, and the frequency of response to therapy was less (40 vs. 62%, p<.01). Conclusions: Serum lactate dehydrogenase provides a convenient and dependable prognostic indicator in patients with multiple myeloma. An elevated LDH value indicates a poor prognosis regardless of ISS stage, confirming the report by Gkotzamanidou, Terpos, and Dimopoulos et al, and should be included in the definition of stage III disease. Such patients require rapid control of disease with sequential combinations of effective drugs and intensive therapy in order to improve their outcome. [Table: see text]

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Role of Serum Lactate Dehydrogenase (LDH) As a Prognostic Marker for Autologous Hematopoietic Stem Cell Transplantation for Multiple Myeloma.

Blood ◽

10.1182/blood.v120.21.3115.3115 ◽

2012 ◽

Vol 120 (21) ◽

pp. 3115-3115

Author(s):

Krina Patel ◽

Robert Z. Orlowski ◽

Nina Shah ◽

Qaiser Bashir ◽

Simrit Parmar ◽

...

Keyword(s):

Multiple Myeloma ◽

Bone Marrow ◽

Stem Cell ◽

Lactate Dehydrogenase ◽

Hematopoietic Stem Cell Transplantation ◽

Serum Lactate ◽

Serum Lactate Dehydrogenase ◽

Hematopoietic Stem ◽

The Impact

Abstract Abstract 3115 Background: The International Staging System (ISS), chromosomal abnormalities, and response to therapy are well recognized predictors of outcome in multiple myeloma (MM). However, the role of serum lactate dehydrogenase (LDH) as a prognostic marker for MM is not well established. Recently we showed that high LDH at diagnosis of MM is a predictor of shorter survival. Here we report the impact of the LDH level at the time of autologous hematopoietic stem cell transplantation (auto-HCT) on its outcome. Methods: We evaluated 1,658 patients with symptomatic myeloma who underwent auto-HCT from July 1988 to December 2010 at our institution. The primary objective was to determine the impact of high LDH (>1000 IU/L) level, obtained on the start day of the preparative regimen, on progression free survival (PFS) and overall survival (OS). Results: Patient characteristics according to LDH level at auto-HCT are summarized in Table 1. Patients in the 2 LDH groups (>1000 or ≤ 1000) were matched for age, gender, disease status, and response to prior therapy at the time of auto-HCT. Patients with LDH >1000 IU/L had a significantly higher beta-2 microglobulin (β2m) and bone marrow plasmacytosis at the time of auto-HCT. Median times to neutrophil (10 vs. 10 days: p=0.10) and platelet engraftment (11.3 vs.12.2 days: p=0.20) were not different in the 2 groups. Also, there was no significant difference in CR, VGPR, PR or overall response rates between the 2 groups. Median follow up was 35 months (1 to 244). Median OS in patients with LDH >1000 and ≤ 1000 were 49.2 and 68.0 months, respectively (p=0.03). Median PFS in patients with LDH >1000 and ≤ 1000 were 14.4 and 24.7 months, respectively (p=0.001). On univariate analyses, >10% plasma cells in bone marrow biopsy, relapsed disease, serum β2M ≥ 3.5 at auto-HCT, presence of any chromosomal abnormality, and < PR after auto-HCT were associated with significantly shorter PFS and OS. Conclusions: Having a serum LDH value of >1000 IU/L prior to auto-HCT is associated with shorter PFS and OS in patients with MM. These high risk patients may require aggressive post-transplant therapy, including consolidation, maintenance, tandem transplants or novel approaches like immunotherapy. Disclosures: Shah: Celgene: Membership on an entity's Board of Directors or advisory committees.

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Correlation Analysis Between Serum Lactate Dehydrogenase and Prognosis in Old New Diagnosed Multiple Myeloma Patients

Blood ◽

10.1182/blood.v128.22.5637.5637 ◽

2016 ◽

Vol 128 (22) ◽

pp. 5637-5637

Author(s):

Yahui Yuan ◽

Yan Gu ◽

Xiaoyan Qu ◽

Qinglin Shi ◽

Hua Bai ◽

...

Keyword(s):

Multiple Myeloma ◽

Lactate Dehydrogenase ◽

Conflicts Of Interest ◽

Prognostic Significance ◽

Progression Free Survival ◽

Staging System ◽

Serum Lactate ◽

Stage Ii ◽

Stage Iii ◽

Serum Lactate Dehydrogenase

Abstract 【Abstract】 Objective Multiple myeloma (MM) is a kind of plasma cell malignancy tumor with larger heterogeneity. Patient's survival varies greatly. This study retrospectively analyzed serum lactate dehydrogenase (LDH) in 107 cases of elderly MM patients, to discuss its correlation with other clinical indicators of MM and the prognostic significance. Methods 107 cases of elderly MM patients were selected from our hospital from July 2008 to January 2016 as the research objects, all of whom were above 60 years and were newly diagnosed. OLIPAS AU5400 fully automatic biochemical analyzer was used to assay serum LDH concentration, and prognosis analysis was carried out combined with patients' clinical data. On this basis, 73 cases of MM patients were given R-ISS staging. Results At primary diagnosis, about 9.4% patients had increased LDH (10/107), with the median follow-up time of 15 (1-88.5) months. Median overall survival (OS) was 52.5±6.9 months in normal LDH group, while 15.5±5.2 (months) in elevated LDH group, and there were statistically significant differences (p<0.001); Median progression free survival (PFS) was 24.0±3.5 months in normal LDH group, while 12.0±10.5 monthsin elevated LDH group, and there were statistically significant differences (p=0.008). Multiple factors analysis showed that LDH was an independent prognosis factor of elderly MM. Median OS of patients was 44 and 72 months (p=0.820) with stage II and stage III of ISS staging, while median PFS was 23 and 22 months (p=0.963); Median OS of patients was 44 and 22.5 months (p=0.308) with stage II and stage III of R-ISS staging, while median PFS was 24 and 14 months (p=0.105). Conclusions LDH is one of the important indicators for prognostic judgment of elderly MM patients. R-ISS staging based on LDH level is superior to the ISS staging system in prognostic judgment. Disclosures No relevant conflicts of interest to declare.

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