SERUM LACTATE-DEHYDROGENASE LEVEL AS A PROGNOSTIC FACTOR IN HODGKINS-DISEASE

The efficacy of currently available treatments for Hodgkin's disease ( HD) has led to a substantial modification in the prognosis of this dis ease; nevertheless there is still a group of patients that cannot be c ured with conventional treatments and who will be candidates for alter native therapy. In the present work we analysed the prognostic influen ce of the most relevant clinico-biological characteristics of HD in a consecutive series of 137 patients diagnosed and treated in a single i nstitution. Univariate analyses identified six variables with signific ant prognostic influence, both on achieving complete remission (CR) an d overall survival (OS); LDH > 320 U ml-1, age > 45 years, stages IIB, III and IV, extranodal involvement, alkaline phosphatase > 190 UI dl and ESR > 40 mm h. In addition, Hb < 12.5 gr dl-1 and abdominal diseas e were statistically relevant for CR while a poor performance score (E COG greater-than-or-equal-to 2) affected a lower survival. In the mult ivariate analysis only LDH, age and the clinical stage retained a sign ificant prognostic influence for achieving CR, while the two first fac tors above, together with performance status were the variables with i ndependent prognostic value with respect to OS. Moreover, only LDH >32 0 U ml-1 had prognostic influence in the probability of relapse and di sease free survival (DFS), both in the univariate and multivariate ana lyses. According to the three independent factors obtained in the mult ivariate analysis for CR (LDH, age and stage) a predictive model was e stablished that allows the stratification of patients into two prognos tic groups: one with poor prognosis that includes patients with the th ree adverse prognostic factors, or two if one of them was elevated LDH , and the other with good prognosis that includes the remaining patien ts. This model was also able to separate two independent groups of pat ients with respect to OS and to DFS. In conclusion, the present study shows that LDH is one of the most important prognostic factors in HD.