HIGH SERUM LACTATE-DEHYDROGENASE LEVEL AS A MARKER FOR DRUG-RESISTANCE AND SHORT SURVIVAL IN MULTIPLE-MYELOMA
HIGH SERUM LACTATE-DEHYDROGENASE LEVEL AS A MARKER FOR DRUG-RESISTANCE AND SHORT SURVIVAL IN MULTIPLE-MYELOMA
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DOI：
10.7326/0003-4819-115-12-931
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发表时间：
1991-12-15
影响因子：
39.2
通讯作者：
ALEXANIAN, R
中科院分区：
文献类型：
--
作者：
DIMOPOULOS, MA;BARLOGIE, B;ALEXANIAN, R
目的：评估血清乳酸脱氢酶（LDH）作为既往未经治疗的多发性骨髓瘤患者的预后因素。设计：391例连续接受统一治疗的多发性骨髓瘤患者的研究，随访至63%的患者死亡。设置：三级转诊癌症中心。患者：共391例连续接受既往未经治疗的有症状的多发性骨髓瘤患者。干预：各种化疗方案，包括阿霉素或糖皮质激素，或两者兼而有之，具有一致的反应率（53%）。测量：结果包括临床反应的基础上计算的肿瘤负荷和生存时间从治疗减少75%。主要结果：11%的患者血清LDH水平高于5.0 μ kat/L（300 U/L）。随着肿瘤负荷的增加，LDH水平升高更常见; 26%的高肿瘤患者LDH水平升高。高LDH水平与浆细胞白血病或淋巴瘤样临床特征（43%）以及浆细胞亚二倍体（17%）相关。只有20%的LDH水平升高的患者对化疗有反应，而LDH水平低的患者的反应率为57%。使用多变量分析，LDH是反应的显著独立预测因子（P = 0.001），比值比为0.25（95%CI，0.11 - 0.57）。高LDH水平与短的中位生存期（9个月）相关，并显示出最高的相对危险度（2.63; CI，1.75至3.95; P = 0.001）。结论：LDH水平升高提示存在隐匿性骨外疾病和高肿瘤肿块。LDH水平是一个预测预后不良的患者应考虑早期强化治疗。
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-mu-kat/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.