From the Research
Lactate dehydrogenase (LDH) is often elevated in Hodgkin lymphoma due to increased tumor cell turnover and tissue destruction, serving as a nonspecific marker of tumor burden and disease activity. As cancer cells proliferate rapidly and die, they release LDH into the bloodstream. In Hodgkin lymphoma specifically, the Reed-Sternberg cells and the surrounding inflammatory cells contribute to this elevation through their metabolic activity and cell breakdown. The elevation occurs because cancer cells preferentially use glycolysis for energy production (the Warburg effect), even in oxygen-rich environments, leading to increased LDH production to convert pyruvate to lactate. Clinically, elevated LDH levels in Hodgkin lymphoma patients are considered a prognostic factor, with higher levels potentially indicating more aggressive disease and possibly poorer outcomes, as noted in various studies 1, 2, 3, 4, 5. LDH levels are typically monitored during treatment to assess response, with decreasing levels suggesting effective therapy and rising levels potentially indicating disease progression or recurrence. Key factors influencing LDH elevation include the stage of the disease, the presence of "B" symptoms, bulky disease, and extra-nodal involvement, as discussed in the context of treatment strategies for Hodgkin lymphoma 2, 3. However, the provided studies do not directly address the mechanisms of LDH elevation in Hodgkin lymphoma, emphasizing the need to consider the underlying biology of the disease and the role of LDH as a marker of cell turnover and metabolism. Given the importance of LDH in assessing disease activity and prognosis, monitoring LDH levels is crucial in the management of Hodgkin lymphoma, allowing for timely adjustments in treatment strategies to optimize patient outcomes. This approach is supported by the principle of using the most recent and highest quality evidence to guide clinical decisions, even though the specific studies provided do not directly focus on LDH elevation mechanisms. In clinical practice, the interpretation of LDH levels must be considered in the context of the individual patient's disease characteristics, treatment response, and overall clinical picture, as informed by the latest research and guidelines in the field of hematology and oncology.