Pretreatment serum levels of lactate dehydrogenase (LD) and beta-2-microglobulin correlate with both the time to treatment failure and the survival seen in patients with diffuse large cell non-Hodgkin's malignant lymphoma. Three prognostic groups (low risk, intermediate risk, high risk) could be identified based upon the serum levels of these 2 analytes.
Treatment protocol:
(1) Alternating CHOP-Bleo (cyclophosphamide, doxorubicin, vincristine, prednisone and bleomycin) with VP-16 (cyclophosphamide, methotrexate, etoposide) and dexamethasone.
(2) Patients previously untreated.
(3) Tumors included: diffuse large cell, immunoblastic lymphoma, diffuse mixed-cell, diffuse small cleaved cell
(4) Tumors not included: low grade lymphoblastic lymphoma, high grade lymphoblastic lymphoma, undifferentiated lymphoma
Definition of high tumor burden:
(1) bulky nodal area = palpable abdominal mass, nodal area > 7 cm, concomitant pelvic and paraaortic adenopathy, mediastinal mass, or head and neck lesion T3 or T4
(2) 2 or more bulky nodal areas
(3) 3 extranodal areas of involvement
(4) 2 extranodal and one bulky area
Factors found on univariate analysis to correlate with time to treatment failure
(1) beta-2-microglobulin: correlated with tumor burden
(2) lactate dehydrogenase (LD): did not correlate with tumor burden
(3) Ann Arbor stage
(4) tumor burden
(5) B clinical symptoms
(6) extranodal disease
Factors identified on multivariate analysis as independent predictors of time to treatment failure:
(1) beta-2-microglobulin (since beta-2-microglobulin is excreted by the kidney, renal failure could result in elevated serum levels unrelated to tumor burden)
(2) LD
Upper limits of normal for analytes:
(1) beta-2-microglobulin: 2 mg/L
(2) LD: 225 U/L
|
Risk Group |
Serum LD |
Serum beta-2-Microglobulin |
|
low |
low (< 250 U/L) |
low (< 3 mg/L) |
|
intermediate |
increased (>= 250 U/L) |
low (< 3 mg/L) |
|
intermediate |
low (< 250 U/L) |
increased (>= 3 mg/L) |
|
high |
increased (>= 250 U/L) |
increased (>= 3 mg/L) |
|
Patient Outcome |
low risk |
intermediate |
high risk |
|
complete response to therapy |
93% |
69% |
44% |
|
relapse within 24 months if initial complete responder |
0% |
0% with low ß2m; 25% with high |
73% |
|
no evidence of disease progression at 24 months for all patients |
100% |
|
14% |
|
survival at 24 months |
100% |
54% |
19% |
Specialty: Hematology Oncology
ICD-10: ,
