The Discussion Of The Level Of Serum Lactate Dehydrogenase In Prognosis Of Myelodysplastic Syndrome And Its Value In Treatment Guidelines

Objective:Retrospective analyze the relationship between serum lactate dehydrogenase(LDH)level and prognosis of 61 newly diagnosed myelodysplastic syndrome(MDS)patients with in the Second Affiliated Hospital of Nanchang University,and explore its value in guiding treatment options.Methods:Collecting basic information,biochemical markers,bone marrow smear reports and immunological test markers from newly diagnosed MDS 61 patients who were admitted to the Second Affiliated Hospital of Nanchang University from January2016 to December 2018.Draw the ROC curve,and the LDH value corresponding to the maximum value of Youden index was selected as the cutoff value.The cutoff value under the cutoff value was 0.802,all patients were divided into 2 groups;Thirty patients'serum lactate dehydrogenase level<233U/L were selected as low value group.Thirty one patients'serum lactate dehydrogenase level?233 U/L were in the high group.The prognosis and treatments efficacy of twogroups were analyzed.Result:1.The enrolled patients were divided into low,medium,high and extremely high risk groups under the IPSS-R stage.The mean values were 221.02±44.72 U/L in the low-risk group,248.01±103.01 U/L in the middle-risk group,263.35±96.97 U in the high-risk group.369.89±267.30 U/L in the extremely high-risk group,the serum LDH level is propotional to the risk stage,and the difference was statistically significant(F=5.169,P<0.05).The LDH level:low-risk group was lower than medium-risk group,the difference was not statistically significant(t=-0.361,P>0.05);low-risk group was lower than high-risk group,the difference was not statistically significant(t=-0.605,P>0.05);low-risk group was lower than extremely high-risk group,the difference was not statistically significant(t=-0.759,P>0.05);medium-risk group was lower than the high-risk group,the difference was statistically significant(t=-0.527,P>0.05);medium-risk group was lower than the extremely high-risk group,the difference was not statistically significant(t=-1.825,P>0.05);high-risk group was lower than extremely high-risk group,the difference was statistically significant(t=-1.851,P<0.05).)?2,Under the LDH level grouping,there was no significant differences in gender,age,WBC,HGB and PLT,and the proportion of primordial cells.Under MDS WHO classification,the proportion of MDS-EB2 in high LDH group was 48.3%,while the number in low LDH group was 33.3%,the difference was not statistically significant(x~2=6.988,P>0.05).Under IPSS-R stage system,the unmber of patients whose score is over 5 points(high risk)in high LDH group is 21(77.8%),while the number in low LDH group is 18(60.0%),the difference was not statistically significant(x~2=7.376,P>0.05);Under the WPSS stage system,the unmber of patients whose score is over3 points(high risk)in high LDH group is 27(87.1%),while the number in low LDH group is 22(73.4%),the difference was not statistically significant(x~2=6.850,P>0.05);Risk factors analysis found that the difference of?-2 microglobulin levels between the two groups was statistically significant(x~2=4.643,P<0.05);in the leukemia transformation analysis,the rate of leukemia transformation in high LDH group(9/31,29.0%)was higher than that in low LDH group(5/30,16.7%),but the difference was not statistically significant(x~2=1.318,P>0.05);Two groups The clinical data before treatment showed that the age,IPSS-R score and karyotype abnormalities were statistically significant(x~2=4.157,P<0.05),(x~2=17.617,P<0.05),(x~2=13.097,P<0.05),while the differences of WBC,HGB and PLT were not statistically significant.The LDH level before treatment in the leukemia transfered group was higher than that in the no leukemia transfered group,but the difference was not statistically significant(F=0.777,P>0.05)?3.The overall response rate of the treatment in low LDH group was higher than high LDH group,48.4%and 43.3%,respectively,but the difference was not statistically significant(x~2=0.157,P>0.05);In low LDH group,we found that there was no statistically significant difference in general clinical data between the group containing decitabine and the no-decitabine group.The overall response rate(ORR)of the two groups was 71.4.%and 18.7%,complete response rate(CR)were 14.3%and 0.0%,partial remission(PR)were 21.4%and 12.5%,respectively,complete bone marrow rate(cMR)was 7.1%and 0.0%,respectively,and hematology improvement(HI)was 28.6.%and 6.3%,stable disease(SD)+progressive disease(PD)rates were28.6%and 81.2%,respectively,and the difference was statistically significant((x~2=9.674,P<0.05);In high LDH group,we found there was no significant difference in the general clinical data between the decitabine-containing and no-decitabine groups.The overall response rate(ORR)was 52.6%and 50.0%,respectively,and the complete remission(CR)was 15.8.%and 0%,partial remission(PR)were 15.8%and 16.7%,respectively,complete bone marrow remission rate was 5.3%and 16.7%,respectively,hematological improvement was 10.5%and 16.7%,respectively,and disease was stable(SD)+disease progression(PD)rates were 52.6%and 50.0%,respectively,and the difference between the two groups was not statistically significant(x~2=0.020,P>0.05)?Conclusion:1.The pre-treatment LDH level in patients with newly diagnosed MDS is positively correlated with the IPSS-R prognostic scores and scores.The pre-treatment LDH level?233 U/L often indicates poor prognosis.LDH level can be used as an marker for prognosis evaluation of patients with MDS.2.This study found that patients with MDS who had pre-treatment LDH levels<233 U/L received a decitabine-containing regimen will have a better prognosis than those who did not receive decitabine,suggesting that pre-treatment LDH levels combined with other markers It can provide reference for clinical selection of decitabine treatment plan.