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Baseline Lactate Dehydrogenase Predicts Early Treatment Failure in Diffuse Large B-Cell Lymphoma Treated With R-CHOP:
Noorwati Sutandyo1, Hilman Tadjoedin1, Nia Novianti Siregar1
1Department of Hematology and Medical Oncology, Dharmais National Cancer Center Hospital, West Jakarta, DKI Jakarta, Indonesia.
Journal of Clinical Medicine Research
|July 23, 2026
Summary
Early treatment failure in diffuse large B-cell lymphoma (DLBCL) is common, especially in real-world settings. Elevated lactate dehydrogenase (LDH) at diagnosis is a key predictor, suggesting closer monitoring for patients with this biomarker.
Area of Science:
- Hematology
- Oncology
Background:
- Diffuse large B-cell lymphoma (DLBCL) treatment failure with first-line R-CHOP is a significant clinical challenge.
- Real-world settings present unique challenges due to late presentation and variable diagnostic access.
- This study investigates predictors of early treatment failure in an Indonesian DLBCL cohort.
Purpose of the Study:
- To identify clinical and laboratory predictors associated with early treatment failure in DLBCL.
- To analyze factors influencing time-to-diagnosis and treatment outcomes in a real-world setting.
- To evaluate the predictive value of baseline characteristics for early treatment failure in DLBCL.
Main Methods:
- Retrospective observational cohort study at a national cancer center in Indonesia.
- Inclusion of adult DLBCL patients receiving first-line R-CHOP with evaluable baseline data.
- Definition of early treatment failure as primary refractory disease or early recurrence within 12 months of complete response.
- Logistic regression analysis for candidate predictors, including age, ECOG performance status, Ann Arbor stage, anemia, and LDH.
Main Results:
- 51.4% of the 105 included DLBCL patients experienced early treatment failure (83.3% primary refractory, 16.7% early relapse).
- Univariate analysis showed associations between unfavorable ECOG, advanced stage, anemia, and elevated LDH with early failure.
- Multivariable analysis identified elevated LDH as the sole independent predictor (aOR 2.41, 95% CI 1.01-5.79).
- Model discrimination was limited (AUC 0.646), indicating baseline clinical variables alone are insufficient for individual prediction.
Conclusions:
- Early treatment failure is frequent in this Indonesian DLBCL cohort and is associated with elevated baseline LDH.
- Elevated LDH serves as a practical warning marker for closer patient monitoring.
- Findings require prospective validation due to the retrospective, single-center design and limited predictive model discrimination.