The Effect of Serum Lactate Dehydrogenase (LDH) Level on the Response to Erythropoiesis Stimulating Agents in Patients with Low and Intermediate Risk Myelodysplastic Syndrome

Abstract

Objective: To evaluate the effect of increased serum lactate dehydrogenase (LDH) level, known as a poor prognostic factor, on the response to erythropoiesis-stimulating agent (ESA) treatment in patients with low and intermediate-1 risk MDS –considered to be a group with good prognosis.

Methodology: We retrospectively identified 47 patients who were treated with ESA (epoetin-? or darbepoetin-?) due to low or intermediate risk MDS according to international prognostic scoring system (IPSS) the patients were evaluated from three different medical centers between 2006 and 2018. Patients’ demographic, clinical and laboratory characteristics (including erythropoietin and LDH levels) were recorded and analyzed with respect to IPSS risk groups and the presence/absence of response to ESA.

Results: The low-risk group consisted of 32 patients, and the intermediate-1 group consisted of 15 patients. Thirty-three patients responded to ESA, while 14 did not. Survival analyses demonstrated that patients with low or normal LDH at baseline had longer survival than those with high LDH, and risk of death was increased by 8.868-fold in patients with high LDH. There was no relationship between LDH level and response to ESA therapy, but female gender increased the likelihood of ESA response by 9.19-fold.

Conclusion: Our findings show that LDH level is one of the predictable factor of survival among patients with MDS; however, it appears that baseline LDH is not associated with ESA response. Besides baseline erythropoietin levels were lower among ESA responders, logistic regression revealed that the only parameter associated with positive response to ESA was female gender.