Serum lactic dehydrogenase level has prognostic value in childhood acute
lymphoblastic leukemia
CH Pui, RK Dodge, GV Dahl, G Rivera, AT Look, D Kalwinsky, WP Bowman, J Ochs, M Abromowitch and J Mirro
Serum lactic dehydrogenase (LDH) levels were measured at diagnosis in 293
children with "standard-risk" acute lymphoblastic leukemia (ALL) to
determine the prognostic value of this biologic feature. Standard risk
assignment was based on an initial leukocyte count of less than 100 X
10(9)/L, the absence of a mediastinal mass, the absence of meningeal
involvement, and the presence of lymphoblasts lacking sheep erythrocyte
receptors or surface immunoglobulin. Serum LDH levels ranged from 97 to
6,595 U/L, with a mean of 547 U/L. Higher LDH levels were associated with
higher leukocyte counts, lower blast cell DNA indices, lower platelet
counts, a larger spleen size, and nonwhite race. LDH levels were not
related to the percentage of marrow S-phase cells, liver size,
French-American-British (FAB) classification, hemoglobin levels, age, sex,
or the presence of the common ALL antigen on marrow blasts. Patients with
the highest LDH levels (greater than 1,000 U/L) were most likely to fail
treatment, whereas those with the lowest levels (less than 300 U/L) had the
lowest risk of failure (P less than .0001). The prognostic significance of
serum LDH level was retained in a subset of patients that included only
those with leukocyte counts less than 25 X 10(9)/L (P = .0018). When 11
presenting characteristics were subjected to multivariate analysis, serum
LDH level was found to have independent prognostic strength, contributing
clinically important information to that gained from leukocyte count. Early
measurement of serum LDH could be useful in identifying a group of
standard-risk ALL patients with a high relapse hazard.
Volume 66,
Issue 4,
pp. 778-782,
10/01/1985
Copyright © 1985 by The American Society of Hematology
