Prognostic implications of the differentiation inhibitory factor nm23-H1 protein in the plasma of aggressive non-Hodgkin's lymphoma

The outcome of patients with non-Hodgkin's lymphoma has been improved by cu rrent approaches to treatment. Nevertheless, many patients either do not ha ve a complete remission or ultimately relapse, To identify such patients, i t is important to be able to predict the outcome. We previously found that the differentiation inhibitory factor/nm23 was correlated with the prognosi s of acute myeloid leukemia. To examine the prognostic effect of nm23 on no n-Hodgkin's lymphoma, we established an enzyme-linked immunosorbent assay p rocedure to determine nm23-H1 protein levels in plasma and assessed the ass ociation of this protein level with the response to chemotherapy, overall s urvival, and progression-free survival in patients with aggressive non-Hodg kin's lymphoma. The plasma concentration of nm23-H1 was significantly highe r in patients with malignant lymphoma than in normal controls, especially i n aggressive non-Hodgkin's lymphoma. The complete remission rate in patient s with higher nm23-H1 levels was significantly worse than that in patients with lower nm23-H1 levels. Overall survival and progression-free survival w ere also lower in patients with higher nm23-H1 levels than in those with lo wer levels. The 3-year survival rates in patients with low and high nm23-H1 levels were 79.5% and 6.7% (P = .0001). A multivariate analysis of prognos tic factors showed that the plasma nm23-H1 level was independently associat ed with the survival and progression-free survival. An elevated plasma nm23 -H1 concentration predicts a poor outcome of advanced non-Hodgkin's lymphom a. Therefore, nm23-H1 in plasma may be useful for identifying a distinct gr oup of patients at very high risk. (C) 1999 by The American Society of Hema tology.