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Published on: October 19, 2014
Serum lactate dehydrogenase-3 isoenzyme in chronic granulocytic leukemia
R M Buchsbaum1, F J Liu, J M Trujillo
1Division of Laboratory Medicine, University of Texas M. D. Anderson Cancer Center, Houston 77030.
Insights
Serum lactate dehydrogenase-3 (LD-3) levels are highly indicative of chronic granulocytic leukemia (CGL) activity. Elevated LD-3, assessed by absolute and relative values, shows potential as a sensitive biomarker for CGL detection.
Area of Science:
- Biochemistry
- Hematology
- Oncology
Background:
- Chronic granulocytic leukemia (CGL) is a myeloproliferative neoplasm.
- Lactate dehydrogenase (LD) is an enzyme with multiple isoenzymes.
- LD isoenzyme patterns, particularly LD-3, have been investigated as potential biomarkers in various cancers.
Purpose of the Study:
- To evaluate the diagnostic utility of serum lactate dehydrogenase-3 (LD-3) activity in patients with chronic granulocytic leukemia (CGL).
- To assess the correlation between LD-3 levels and CGL disease status (active, partial remission, complete remission).
- To determine the optimal criteria for measuring LD-3 to maximize clinical sensitivity.
Main Methods:
- Serum samples from patients with active CGL, partial remission, and complete remission were analyzed.
- Electrophoresis was used to determine LD isoenzyme patterns.
- Three criteria for LD-3 elevation were defined: criterion-1 (ratio and absolute value), criterion-2 (ratio only), and criterion-3 (absolute value only, with isomorphic elevation).
Main Results:
- Abnormal LD-3 activity was observed in 92% of active CGL patients, 40% in partial remission, and 13% in complete remission.
- Criterion-3 (absolute LD-3 elevation with isomorphic isoenzyme elevation) increased sensitivity for active CGL from 82% to 92%.
- Mean serum LD-3 and total LD activity differed significantly between disease states but not within active CGL subgroups.
Conclusions:
- Evaluating serum LD-3 in both absolute and relative terms enhances its clinical sensitivity for CGL.
- LD-3 shows promise as a useful biomarker for monitoring CGL.
- Further investigation into unexplained LD-5 elevations in remission patients may be warranted.
Abstract:
Abnormal levels of serum lactate dehydrogenase-3 (LD-3) activity were observed in 92% of patients (35 of 38) with active chronic granulocytic leukemia (CGL), in 40% of patients (4 of 10) in partial remission, and in 13% of patients (1 of 8) in complete remission. In evaluating the electrophoretic LD isoenzyme patterns of these patients, three criteria were used. In criterion-1 elevations, the LD-3/total LD ratio, expressed as a fraction of serum total LD, and LD-3 value, expressed in absolute units, were greater than the upper limit of the reference range. In criterion-2 elevations, only the LD-3/total LD ratio was greater than the upper limit of the reference range. In criterion-3 elevations, only the absolute LD-3 activity exceeded the upper limit of the reference range, and these specimens showed isomorphic elevation of all five LD isoenzymes. Use of the last of these criteria increased the clinical sensitivity of serum LD-3 elevations in active CGL from 82% to 92%. The mean serum LD-3 absolute value and serum total LD activity usually showed statistically significant differences (P less than 0.05) among patients with active CGL, those in partial remission, and those in complete remission, but did not distinguish between subgroups of individuals with active CGL. Elevation of the serum LD-5/total LD ratio in 16 of 58 patients was due to hepatic injury or methodologic imprecision, showing analytically insignificant, borderline abnormalities in all cases of active CGL. In 10 of 62 patients in complete remission or partial remission, however, such elevation was unexplained. Our results indicate that the evaluation of serum LD-3 values in both absolute and relative terms slightly increases the clinical sensitivity of LD-3, and, therefore, suggest that LD-3 might be a useful marker for CGL.
