From the Guidelines
Yes, ESR and CRP are often elevated in patients with lymphoma, as these inflammatory markers rise in response to the systemic inflammation caused by the disease. The elevation of ESR and CRP in lymphoma patients is attributed to the release of inflammatory cytokines, such as interleukin-6, which stimulates the liver to produce acute phase reactants, including CRP 1.
Key Points to Consider
- ESR and CRP are non-specific markers that can be elevated in various inflammatory conditions, infections, and malignancies, and therefore, cannot alone diagnose lymphoma 1.
- The degree of elevation of these markers may correlate with disease stage, tumor burden, and prognosis in some lymphoma types, with higher levels often associated with more advanced disease 1.
- Elevated ESR and CRP should prompt further investigation, including a thorough medical history, physical examination, and diagnostic work-up, such as chest X-ray, contrast-enhanced computed tomography (CT) scan, and whole-body positron emission tomography (PET) scan, to determine the underlying cause of the elevation 1.
Clinical Implications
- The European Organisation for Research and Treatment of Cancer (EORTC) and the German Hodgkin Study Group (GHSG) definitions of limited, intermediate, and advanced stages of lymphoma take into account the elevation of ESR and CRP, among other factors 1.
- The presence of elevated ESR and CRP, particularly in patients with Hodgkin lymphoma, may indicate a higher risk of advanced disease and poorer prognosis, highlighting the importance of prompt and accurate diagnosis and treatment 1.
From the Research
Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) in Lymphoma
- ESR and CRP are inflammatory markers that can be elevated in patients with lymphoma 2, 3, 4, 5, 6
- Studies have shown that elevated ESR and CRP levels are associated with advanced disease, poor prognosis, and increased risk of venous thromboembolism (VTE) in patients with lymphoma 2, 3, 4, 5, 6
- Specifically, a study published in 2022 found that ESR, CRP, and other inflammatory markers were significantly higher in patients with lymphoma who developed VTE 2
- Another study published in 1993 found that ESR and CRP were elevated in patients with non-Hodgkin's lymphoma and chronic lymphocytic leukemia, although the increase was less marked compared to other tumor markers 3
- A study published in 2013 found that elevated CRP levels were associated with poor prognosis and inferior overall survival in patients with extranodal natural killer/T-cell lymphoma 4
- A study published in 2024 found that elevated CRP levels were associated with advanced disease and poor treatment response in patients with Hodgkin's lymphoma 5
- A study published in 2018 found that an ESR of more than 37.5 mm/hour was an effective predictor of outcome in diffuse large B-cell lymphoma patients 6
Association with Clinical Characteristics
- Elevated ESR and CRP levels have been associated with advanced Ann Arbor stage, poor performance status, elevated lactate dehydrogenase level, and presence of B symptoms in patients with lymphoma 2, 3, 4, 5, 6
- High ESR and CRP levels have also been associated with non-germinal-center B-cell subtypes and Myc protein positivity in patients with diffuse large B-cell lymphoma 6
- Dynamic changes in ESR and CRP levels can be valuable in assessing treatment response and predicting disease recurrence in patients with lymphoma 6