Danieu et al separated patients with diffuse histiocytic lymphoma into prognostic groups based on serum LDH levels and the sites of tumor involvement. This can help identify patients who may benefit from more aggressive therapy, and can aid in the interpretation of a treatment effectiveness. The authors are from Memorial Sloan-Kettering Cancer Center in New York.
Parameters:
(1) serum LDH
(2) level of site involvement (LSI)
Parameter |
Finding |
Group |
serum LDH |
< 225 U/L |
low |
|
225 – 500 U/L |
medium |
|
> 500 U/L |
high |
level of site involvement |
peripheral lymph nodes +/- Waldeyer ring involvement +/- spleen |
I |
|
extranodal disease +/- peripheral lymph nodes |
II |
|
retroperitoneal lymph nodes +/- peripheral lymph nodes |
III |
|
bulky mediastinal disease +/- any other disease group |
IV |
|
extranodal disease + retroperitoneal lymph nodes +/- peripheral lymph nodes |
V |
where:
• The LDH was done as part of an SMA-12. The upper limit of the normal reference range for LDH was 225 U/L.
LDH |
LSI |
Stage |
Alive at 48 Months |
low |
any |
I |
80% |
medium |
Group I or II |
II |
50% |
high |
Group I or II |
III |
35% |
medium |
Group III, IV or V |
III |
35% |
high |
Group III, IV or V |
IV |
15% |
Limitations:
• The survival in patients has probably improved since 1986, but the relative severity of disease should still be relevant.
Specialty: Hematology Oncology