Would C-Reactive Protein (CRP) be elevated in lymphoma?

CRP Elevation in Lymphoma

Yes, C-reactive protein (CRP) is frequently elevated in lymphoma patients, serving as both a marker of disease activity and a prognostic indicator.

CRP in Different Lymphoma Types

• Hodgkin Lymphoma (HL):

  • Elevated CRP is found in approximately 64% of pediatric and adolescent HL patients 1
  • Higher CRP levels correlate with advanced disease stage and presence of B symptoms 2
  • CRP levels during treatment can predict treatment response, with persistent elevation suggesting refractoriness 2

• Non-Hodgkin Lymphoma (NHL):

  • In diffuse large B-cell lymphoma (DLBCL), baseline CRP levels correlate with International Prognostic Index (IPI) scores and overall survival 3
  • In follicular lymphoma, patients with CRP >5 mg/L have significantly shorter progression-free survival 4
  • In extranodal NK/T-cell lymphoma, high CRP (>10 mg/L) is associated with inferior progression-free and overall survival 5

Mechanism of CRP Elevation in Lymphoma

CRP elevation in lymphoma reflects the underlying inflammatory response triggered by the malignancy. This occurs through:

1. Cytokine-mediated inflammation: Lymphoma cells and the tumor microenvironment produce pro-inflammatory cytokines (IL-6, TNF-alpha) that stimulate CRP production in the liver 6

2. Systemic inflammatory response: The archetypal acute phase reactant CRP serves not only as a marker but potentially as a mediator of disease progression 6

Clinical Significance of CRP in Lymphoma

• Diagnostic value: While not specific for lymphoma, elevated CRP can be part of the initial workup

• Prognostic value:

  • Higher baseline CRP correlates with:
    • Advanced disease stage 2, 1
    • Presence of B symptoms 2
    • Poorer treatment response 2, 3
    • Inferior survival outcomes 5, 4, 3

• Treatment monitoring:

  • CRP normalization during treatment correlates with complete response 2
  • Persistent elevation suggests treatment refractoriness 2

Interpretation of CRP Values

• Normal range: <10 mg/L (though cutoffs vary by laboratory)
• Mild elevation (10-40 mg/L): Common in lymphoma, particularly in early stages
• Moderate to severe elevation (>40 mg/L): Often seen in advanced disease, presence of B symptoms, or aggressive subtypes 7

Clinical Application

• Include CRP measurement in initial lymphoma workup
• Monitor CRP levels during treatment as an additional marker of response
• Consider more aggressive treatment approaches for patients with significantly elevated baseline CRP
• Recognize that persistent CRP elevation during treatment may indicate inadequate response and need for treatment modification

Limitations

• CRP is a non-specific inflammatory marker and can be elevated in various conditions including infections, other malignancies, and autoimmune disorders
• CRP interpretation should always be done in clinical context alongside other findings
• Single measurements are less valuable than serial measurements for monitoring disease activity

CRP represents a simple, widely available, and cost-effective biomarker that provides valuable prognostic information in lymphoma patients and can help guide treatment decisions and monitoring.