HIGH SERUM LEVELS OF LACTIC-DEHYDROGENASE IDENTIFY A HIGH-GRADE LYMPHOMA-LIKE MYELOMA
HIGH SERUM LEVELS OF LACTIC-DEHYDROGENASE IDENTIFY A HIGH-GRADE LYMPHOMA-LIKE MYELOMA
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DOI：
10.7326/0003-4819-110-7-521
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发表时间：
1989-04-01
影响因子：
39.2
通讯作者：
ALEXANIAN, R
中科院分区：
文献类型：
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作者：
BARLOGIE, B;SMALLWOOD, L;ALEXANIAN, R
尽管恶性淋巴瘤患者预后严重，但多发性骨髓瘤患者通常不会出现高水平的血清乳酸脱氢酶（LDH），多发性骨髓瘤是一种主要由分化末期的B细胞组成的惰性肿瘤。因此，118例骨髓瘤早期患者中仅2例显示LDH明显升高至500 U/L以上，而64例晚期疾病进展患者中有12例存在此类异常，尽管接受了长春新碱、多柔比星（阿霉素）、地塞米松（VAD）治疗（中位LDH水平，700 U/L）。高LDH水平与高血清β-2-微球蛋白水平、高钙血症、骨外疾病特征、早期临床病程短以及随后生存时间短相关。在LDH较低的患者中也观察到预后不良，其中高剂量化疗诱导了LDH显著升高;因此，在约50%的VAD耐药骨髓瘤患者中观察到在高剂量细胞毒性治疗之前或之后LDH升高至大于300 U/L，并定义了一种具有骨外疾病特征和异常侵袭性病程的新临床实体（“高级别骨髓瘤”）。新诊断的LDH水平正常高值患者的生存期短于LDH水平正常低值患者（< 200 U/L），无论肿瘤质量如何，这表明在一些患者中存在高LDH产生的肿瘤亚群，其逃脱了标准治疗的生长控制。因此，除了β-2-微球蛋白分析和肿瘤质量估计之外，多发性骨髓瘤的分期还应包括血清LDH水平的测量。
Although conferring a grave prognosis in patients with malignant lymphoma, high levels of serum lactic dehydrogenase (LDH) are usually not seen in patients with multiple myeloma, a more indolent tumor composed mainly of B cells in their terminal stage of differentiation. Thus, only 2 of 118 patients in earlier phases of myeloma showed marked LDH elevations to more than 500 U/L, whereas such abnormalities were present in 12 of 64 patients with advanced disease progressing despite treatment with vincristine, doxorubicin (Adriamycin), dexamethasone (VAD) (median LDH level, 700 U/L). High LDH levels were associated with high serum levels of beta-2-microglobulin, hypercalcemia, extraosseous disease features, a short preceding clinical course as well as a short subsequent survival time. A poor prognosis was also noted in patients with lower LDH in whom marked increments were induced by high-dose chemotherapy; thus, LDH elevations to greater than 300 U/L present before or found after high-dose cytotoxic therapy were observed in about 50% of patients with VAD-resistant myeloma and define a new clinical entity with features of extraosseous disease and an unusually aggressive course ("high-grade myeloma"). The shorter survival of newly diagnosed patients with high-normal compared with those with low-normal LDH levels (< 200 U/L), regardless of tumor mass, suggests the presence in some patients of a tumor subpopulation with high LDH production that escapes growth control with standard treatment. Staging of multiple myeloma should therefore include measurements of serum LDH levels in addition to beta-2-microglobulin analysis and tumor mass estimation.