AML-029: The Prognostic Significance of Serum Lactate Dehydrogenase Level in Egyptian AML Patients

Abstract

Context Acute myeloid leukemia (AML) is a clonal heterogeneous disorder. Poor-risk cytogenetics, and older age have been considered adverse risk factors for AML survival. Other factors that may predict prognosis are not as well described. Elevated lactate dehydrogenase (LDH) levels are considered as an unfavorable prognostic factor for several malignancies, including acute leukemias, due to the tumor burden activity which reflects the function of leukemic cell turnover and cell destruction. Objective The current study intended to determine the clinical characteristics and risk factors affecting the outcome of patients with AML. Design This was an observational prospective study from October 2016 till 2017. Setting It was carried out in the Hematology unit at Oncology Center Mansoura University (OCMU). Patients This study was carried out on 40 de novo AML patients in comparison with 10 adult healthy controls. They were M/F 19/21 (47.5/52.5%), mean age 44.3±15.1 years. The FAB classification: 20% were M1, 25% were M2, 32.5% were M4, 17.5% were M5, 5% were M6 and no M0 or M7, and M3 was excluded. Four patients (10%) had a favorable risk, 33 (82.5%) had an intermediate risk, and 3 patients (7.5%) with unfavorable risk. At the end of the study,11 were alive. Interventions The patients were subjected to the routine history taking, physical examination, and laboratory investigations for the workup of AML. The enrolled cases received standard induction, consolidation and salvage chemotherapy protocols. Main Outcomes Measures: The median LDH level was 731.5 (188-6292) U/L. It was highly elevated in almost all patients [39 out of the 40 enrolled patients]. Results Cox regression analysis was conducted for prediction of overall survival (OS) within studied AML patients; using age, gender, laboratory and conventional karyotyping as covariates. High LDH levels were associated with shorter cumulative 1 year OS within studied AML patients in uni- (P=0.018, HR: 1.012, 95% CI 1.005-1.071) and multivariate (P= 0.031, HR: 1.023, 95% CI 1.002-1.091) analyses. Conclusions High LDH levels are considered as poor prognostic factor for prediction of shorter survival. Those patients who have higher LDH levels at diagnosis should be closely observed.