Plasma lactic dehydrogenase and phosphohexose isomerase in leukemia

Two enzymes, lactic dehydrogenase (LD) and phosphohexose isomerase(PHI), were measured in the plasma of 30 patients with leukemia and compared with the findings in 66 control subjects. Abnormally elevated PHIlevels were found in both acute and chronic myelocytic leukemia, but notin lymphocytic leukemia. The plasma LD was increased above normal inacute and chronic myelocytic leukemia, in acute lymphocytic, but not inchronic lymphocytic leukemia. Both enzymes were normal or only slightlyraised in three patients with the aleukemic type of the disease. Hemolyticanemia in seven leukemic patients was associated with high plasma LD valuesin the presence of relatively low PHI levels.

Results of serial enzyme studies from the time of diagnosis until deathindicated that both plasma enzymes, but especially the LD, usually reflectedchanges in the course of the disease-falling during remissions and risingduring relapses. In most cases this enzyme paralleled the leukocyte levelbut occasionally indicated the onset of a relapse or remission before thewhite cell count had begun to change.

Submitted on June 28, 1957 Accepted on November 18, 1957     

Plasma and intracellular levels of lactate dehydrogenase,phosphohexose isomerase and lysozyme activity in acute leukemia

Summary Plasma and intracellular levels of lactate dehydrogenase (LDH), phosphohexose isomerase (PHI) and lysozyme activities were investigated in 20 patients with acute myelocytic leukemia (AML), 18 patients with acute lymphatic leukemia (ALL) and 10 patients with chronic myelocytic leukemia in blast transformation (CML/BT). Though the plasma levels of LDH and PHI in all patients with acute leukemia were elevated as compared to control persons there was no distinctive pattern which could be of use in the classification of acute leukemia. On the other hand the intracellular levels of these enzymes could be of value in classifying acute leukemia. The leukemic lymphoblasts were characterized by low levels of PHI and lysozyme as compared to leukemic myeloblasts or to normal lymphocytes (p<0.01). The LDH/PHI ratio is also significantly higher in leukemic lymphoblasts than in leukemic myeloblasts or in normal lymphocytes (p always <0.01). These characteristics might also be made use of in identifying the blasts of CML/BT als lymphoid or myeloid in corresponding cases.     

Clinical value of lactic dehydrogenase activity in diagnosis of malignant effusion

Summary LDH activity of serous effusion was compared with LDH activity of serum obtained at the time of diagnostic tap. No significant elevation was found in 3 of 7 patients with effusions due to cancer, but the LDH activity was elevated in 5 of 25 patients with nonmalignant effusions. The diagnosis of cancer as the cause of the effusion may be suspected but cannot be established or excluded solely on the basis of the LDH activity in the effusion as compared with that in serum. GOT, GPT, and SDH activities of the effusion have no diagnostic significance.The study reported here was supported in part by American Cancer Society Grant P-242 and U.S.P.H.S. Grants A-3027 and C-4697.     

Cerebrospinal fluid ferritin in patients with leukaemia and malignant lymphoma

To evaluate whether cerebrospinal fluid (CSF) ferritin could be of diagnostic value in haematological malignancies with central nervous system (CNS) involvement, the ferritin concentration was measured in 21 patients with acute leukaemia and lymphoma. Of the 17 patients without CNS involvement, 16 had CSF ferritin values in the normal range (2-7 micrograms/l); 1 patient had an elevated value, probably due to blood contamination in connection with a very high serum ferritin level. 4 patients had tumour invasion of the CNS indicated by the presence of blastic cells in the CSF; CSF ferritin levels in these patients were likewise in the normal range. There was no difference between CSF ferritin values in patients with and without CNS involvement. With the present assay, measurement of CSF ferritin appears to be irrelevant in the evaluation of CNS invasion in haematological malignancies.     

Platelet heterogeneity based on lactic dehydrogenase activity

Mean lactic dehydrogenase (LDH) activity of human platelets is about 5 nU/platelet; expressed on a cell volume basis, it is 0.5 nU/fl. Platelet separation by means of centrifugation on a Percoll discontinuous gradient gives different subpopulations with a clear-cut change of LDH at a mean platelet volume (MPV) of about 6 fl. The LDH content of platelets with a MPV > 6 fl is constant (about 0.5 nU/fl), while that of small platelets (3 < MPV < 6 fl) is inversely correlated with the MPV and reaches a value of 1.5-2.0 nU/fl. Because small platelets are granule-depleted, we suggest that platelet LDH activity be considered as an in vivo activation index.     

Endoscopic diagnosis of lower intestinal lesions of leukaemia and malignant lymphoma

There have been only a few endoscopic studies with respect to lower intestinal lesions of leukaemia and malignant lymphoma, although there have been many autopsy studies of these lesions. The aim of this study was to clarify these lesions using endoscopy. Colonoscopy was performed on 11 of 341 patients with leukaemia and on 32 of 105 patients with malignant lymphoma for frequent diarrhoea, anal bleeding or abnormal findings on barium enema examination, between April 1984 and September 1994. In eight of the 11 patients with leukaemia on whom endoscopy was performed, nine lesions were found; aphthoid ulcers, small ulcers or large tumours due to leukaemic infiltration were found in five, and colorectal adenoma was found in only one patient. Antibiotic-associated haemorrhagic colitis or pseudomembranous colitis was found in one patient each. In 10 of the 32 patients with malignant lymphoma, 11 lesions were found. The following were found in one patient each: large lymphomatous tumours, a large lymphomatous ulcer, multiple small polypoid lesions, multiple lymphomatous polyposis; and colorectal cancer or adenoma in six patients. However, the autopsy findings in patients with both diseases were mostly pseudomembrane formation or ulcers due to fungal and/or bacterial infection. It is concluded that accurate endoscopic diagnosis of lower intestinal lesions in patients with leukaemia or malignant lymphoma is essential for staging and treatment of these diseases and for determining their prognosis. Most lesions in leukaemia are aphthoid and small ulcers are due to leukaemic infiltration or antibiotics; most lesions in malignant lymphoma are elevated lesions such as cancer, adenoma or lymphomatous lesions as determined by endoscopy. This is in contrast to pseudomembrane formation or ulcers due to fungal and/or bacterial infection which are detected at autopsy.     

Prognostic value of the determination of serum lactic dehydrogenase and its isoenzymes in children with acute lymphoblastic leukaemia

Serum total lactic dehydrogenase (LDH) levels have been found to be significantly higher in 21 children with acute lymphoblastic leukaemia (ALL) at initial diagnosis than the values of 12 children who achieved remission. The mean value of serum LDH levels in patients with high-risk factors was 2347 +/- 1490 U/ml (range 430-5460 U/ml), while in patients at standard risk it was 652 +/- 385 U/ml (range 110-1320 U/ml). The serum LDH values were above 1320 U/ml in 70% of the 13 children with high-risk factors. The serum isoenzyme patterns were analyzed in 17 of these children at the initial diagnosis. Although LDH-3 and LDH-2 were prominent at the time of diagnosis; LDH-2 and LDH-1 were the predominant isoenzymes in remission. The highest concentrations of LDH-3 were observed in the high-risk group at diagnosis and the ratio of LDH-3 to LDH-2 exceeding 1.0 was found in children who had high-risk factors, but not in any patients in the standard risk group.