Increased Serum Lactate Dehydrongenase Should Be Included Among the Variables That Define Very-High-Risk Multiple Myeloma

In 203 consecutive unselected patients with symptomatic MM who received upfront treatment with novel agents, high levels of serum LDH were independently associated with poor survival and could identify subgroups of patients within ISS-2 and ISS-3 with even worse outcome. Evaluating serum LDH levels is a simple, inexpensive, and readily available procedure that could be considered among the variables that define very-high-risk MM. Background: In patients who have symptomatic multiple myeloma (MM), a high serum lactate dehydrogenase (LDH) level is associated with features of advanced disease, adds prognostic value to the international staging system (ISS) and predicts for inferior survival. However, it has not been clearly defined what the impact of this abnormality is for patients treated upfront with novel agent-based regimens. Patients and Methods: To address this issue we analyzed 203 consecutive unselected patients with symptomatic MM who received upfront treatment with novel agents in a single center. Results: The median overall survival for patients with normal LDH was 54 months but in patients with increased LDH levels it was 21 months (P = .003), whereas increased serum LDH was associated with a higher probability of early death. Multivariate analysis confirmed that an increased LDH level is independently associated with poor survival. Furthermore, increased LDH levels could identify subgroups of patients within ISS-2 and ISS-3 with even worse outcome. Conclusion: We conclude that serum LDH is a simple, inexpensive, and readily available blood test that may be included among the variables that define very-high-risk MM.