LDH is an adverse prognostic factor independent of ISS in transplant-eligible myeloma patients receiving bortezomib-based induction regimens

Abstract

BACKGROUND: Serum lactate dehydrogenase (LDH) has been an adverse prognostic factor for myeloma but does not feature in the International Staging System (ISS). We examined if elevated serum LDH at diagnosis remains an adverse risk factor independent of ISS for survivals transplant-eligible myeloma patients receiving early/frontline bortezomib-based induction, followed by autologous stem cell transplantation (ASCT). PATIENTS: Seventy-seven transplant-eligible Chinese patients received three induction regimens [staged approach (N=25), PAD (N=19), VTD (N=33)], followed by ASCT and thalidomide maintenance. RESULTS: Five-year overall (OS) and event-free (EFS) survivals were 66.4% and 36.2%. There was no difference in demographics, CR/nCR rates post-induction or -ASCT, and survivals among patients induced by the three induction regimens. Elevated LDH was associated with male gender (p=0.006), ISS III (p=0.042) and serum β2-microglobulin (p=0.040). Univariate analysis showed that elevated LDH, ISS III, high β2-microglobulin and failure to attain CR/nCR post-ACST were risk factors adversely impacting both OS and EFS. Multivariate analysis showed that elevated LDH was the only factor impacting both OS (p=0.007) and EFS (p=0.008). CONCLUSION: In this uniformly treated cohort of transplant-eligible myeloma patients, elevated serum LDH is an adverse risk factor independent of ISS for both OS and EFS. Bortezomib-based induction/ASCT regimen had not abolished the adverse impact of elevated LDH. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.