Slightly raised LDH post complete remission...what does this mean?

Sunny_days

Hi Everyone,

My dad suffered with Diffuse Large B Cell Lymphoma and was lucky enough to achieve complete remission post R-CHOP and 2 rounds of Methetrexate.

28 months post CR he's having routine blood tests every 6 months. This week all his bloods were looking positive e.g. Lymphocytes were finally back to normal etc which is fantastic. The only result which was a bit off was his LDH level. It was 496 and had risen from 466 over three months. His consultant said this was slightly above the UNL (upper normal limit) of 480 but wasn't a worry at this stage. She said because it's risen slowly over the last few months she'll pop a blood test in for 3 months time but reiterated not to worry...

...of course this has been quite triggering for me and I can't help but get myself in to a panic. I wondered if anyone knew more about LDH or has had a similar situation?

Many thanks in advance

po18guy

My blood numbers would cause many primary physicians to admit me to intensive care. My LDH is always elevated. My creatinine is always high, white count consistently low, red count and hemoglobin always low. Abnormal is the new normal.

Injury, exercise, and healing all cause elevated LDH, which is only a measure of tissue breakdown. As to concern or worry, take your cues from doctor.

ShadyGuy

Best not to worry too much about only one test showing slightly elevated LDH. Remember there is a margin of error on tests. Also, as Po said, many harmless things can elevate LDH, especially exercise. If it shows up high consistently then have it looked into. All my best wishes for you and your Dad. Have a wonderful holiday weekend if you are in US.

Sunny_days

Hi @po18guy and @ShadyGuy

Firstly, thank you so much for taking the time to reply, it means a lot.

@po18guy Abnormal is the new normal. I like that. I didn't realise some of those things could cause an elevated LDH so that give me some reassurance that is isn't always bad news.

@ShadyGuy absolutely, and his consultant said it's the ULN at 496 (480 being top of the range) but Dr. Google (I know, I know) often says 280 or 300 is seen as the top of the range. That being said, when he was admitted last time it was almost 800. I think it's the slow increase over time I'm concerned about.

Sorry for the rambling, nice to be able to write it down and talk about it.

Enjoy your weekends :)

po18guy

LDH is like elevated PSA in men. Many men with elevated PSA never get prostate cancer and many with prostate cancer have normal levels of PSA. Doctor may appear more relaxed as doctor is looking at the big picture, placing everything in context and along a time line so that any worrying trends may be addressed.

Max Former Hodgkins Stage 3

https://csn.cancer.org/discussion/comment/1697899#Comment_1697899

Po, I too like your line here about routine results that would 'get you admitted to ICU. ' After discharge from a month in ICU when I was 30, following my severe auto crash, I returned some months later to the hospital to visit the various clinics and staff who had worked on me. The head R/T was training a new tech, and she told the girl, "You have GOT to see his blood gases !" Back then, all medical records were on paper, and she dug around for a time but could not find my file right off. She then said, " His arterial blood gases results did not indicate LIFE." So, I guess my test results could have got me admitted to the morgue. Around that time, when I first went on a ventilator, a pulmonologists came out to my family and said to them, "IF he lives, which I do NOT expect, he will almost definitely have serious organic brain damage." I also had bilirubin (liver pigmentation) of over 18.00, whereas normal high is between .2 and .5 -- so a minimum of 36 times normal high. An internal med guy told the family I was apparently going in to total liver failure also. My point is that radically skewed results do not a funeral make ! As the state motto of SC proclaims, 'Whilst I breathe, I hope.'

Max Former Hodgkins Stage 3

https://csn.cancer.org/discussion/325339/slightly-raised-ldh-post-complete-remission-what-does-this-mean

Sunny,

I have followed my LDH carefully over the years, since my results for that tests were often "odd." For one, with advanced bulky disease lymphoma before treatments began, my LDH was NORMAL. During treatment, the level went to, I believe, around 700 or higher. But by the end of chemo, it was back down to around normal. Everywhere that I have checked indicates that a normal upper level is 250, so 466 is not 'slightly raised.' At first, I thought perhaps your figure was a misprint, or that his lab uses different units of measure.

Numerous things can cause high LDH, which basically is a measure of cell death, from tissue disease or damage. It used to be routinely drawn when people arrived in an ER with possible heart attack, and some hospitals still use it for that reason. Liver or kidney diseases are another common cause for elevation. Regardless, I would demand that the oncologist follow this closely.

po18guy

https://csn.cancer.org/discussion/comment/1697920#Comment_1697920

It can also indicate an auto-immune condition - a distinct possibility since the immune system was first cancerous, then was assaulted with as much toxicity as the host could tolerate. How that same immune system acts in recovery is anyone's guess.

ShadyGuy

There is no “one way” of measuring LDH. What you need to look at is is what is consideredthe normal range for your particular lab.

Evarista

Just a note on LDH normal ranges: at my institution, 125 - 220 U/L. At my friend's institution, 313 - 618 U/L. Both NCI-designated cancer treatment facilities. Not a good idea to compare your results with those from other places. Best of luck going forward.

Max Former Hodgkins Stage 3

"Best,"

Sunny ASKED for our views regarding the LDH results. Comparisons of all manner of results and what they portend is most of what takes place here. It is obvious from her statement that '466 is somewhat above normal' that the lab involved uses the virtually universal range that holds high normal at or near 250. Everyone knows to compare apples to apples,

Toddles,

ShadyGuy

I have two providers. Duke normal range is 100-200 while Inova normal range is 125-331. Go figure.

ShadyGuy

Sunny

Sign your Dad up for MyChart. His test results along with the normal ranges for that particular lab should show up there under the tab for “test results”.

Evarista

https://csn.cancer.org/discussion/comment/1697932#Comment_1697932

Um, just making a comment related to Sunny's OTHER mention: "...Dr. Google (I know, I know) often says 280 or 300 is seen as the top of the range.". Apologies for the inadvertent truncation of my "Best of luck".

po18guy

Facilities have differing standard ranges, apparently. At SCCA in Seattle, the standard range is <210 U/L (units per liter). Don't believe I've ever seen the lower side of that. As stated, there can be many non-cancerous reasons for a high reading.

Sunny_days

https://csn.cancer.org/discussion/comment/1697919#Comment_1697919

Thanks Max and I'm so very glad they were wrong! I'm feeling a little better over the last couple of days and my head is more focused on living and enjoying the moment. Appreciate all your input and help :)

Sunny_days

https://csn.cancer.org/discussion/comment/1697928#Comment_1697928

Hi Evarista, thank you so much for taking the time to respond, this is very interesting and explains why there are so many different numbers dotted around the internet. From what I can tell, 480 is the UNL based on the range he's been provided with. So he's not massively above that UNL.

Is it that different institutions believe there are different UNLs or is it that they way they test / measure is different?

Thanks for the kind wishes too :)

Evarista

https://csn.cancer.org/discussion/comment/1697981#Comment_1697981

It has to do with the testing method . This quote is from testing.com, but you can find similar on many laboratory testing/clinic websites: "LDH reference ranges are set by the laboratory that is evaluating the blood or fluid sample based on their equipment and methodology. Because reference ranges can vary by laboratory, it is important for a health care provider to help you interpret your test results. (bolding is mine).

Hope that all is OK with your dad.

ShadyGuy

I asked how my lab results for ldh were interpreted. Both my providers say they go by the range indicated on the lab report. No arbitrary numbers assumed.