Phase-related updates in the diagnosis and follow-up management of patients with chronic myeloid leukemia
Year: 2026
Type: article
Study design: Observational Study
Abstract: Introduction. The increase of lactate dehydrogenase (LDH) level is regarded as a common biochemical marker of neoplastic proliferation and anaerobic metabolism, and it has been asserted as an unfavorable prognostic factor in leukemias and malignant lymphomas. The regular determination of LDH and BCR::ABL1 transcripts during the diagnosis and monitoring of chronic myeloid leukemia (CML) subjects could deem as markers for treatment continuation. Objective. This research aimed to assess and update the biochemical and molecular-genetic profile of CML at diagnosis and follow-up. Materials and method. Our analytical and cohort study included 193 prospective and retrospective cases with late chronic phase (CPh) of CML treated between 2016 and 2025 in the Hematology Division of the Oncology Institute from Chişinău, Republic of Moldova. The control group comprised CML cases with early chronic phase. Peripheral blood samples were collected for quantitative RT-PCR, biochemical tests (alkaline phosphatase – ALP, LDH) and molecular-genetic detection of T315I mutation of the BCR::ABL1 gene, in order to assert the diagnostic and prognostic significance of these biochemical parameters and molecular aberration. Results. The researched cohort of CML patients comprised 104 (53.9%) males and 89 (46.1%) females with CPh, and the average age was 47.5 years old (m=1.02; F=0.251). In the overwhelming majority of CML cases (151/78.2%), the elevated levels of LDH were found in the venous blood samples, while the ALP levels increased in 48 (30%) of cases. The statistically significant elevation was assigned to ALP (p<0.05) and LDH (p<0.01) values, which rose from 207.5 U/L and 460.07 U/l in the early CPh up to 1516 U/L and 2509 U/L in the late CPh, correspondingly. In most subjects (71.8%), the BCR::ABL1 transcripts expression surpassed 65%. The b3a2 transcript proved to be the most common (65 cases or 53.3%; p<0.001). The global survival (GS) of patients with normal LDH levels at diagnosis was 100% within one year, 93.7% within five years and 84.4% within 10 years (M=221.090 months; 95% Confidence Interval; 187.788-254.392). The GS proved to be inferior in cases with LDH levels of 1001-1250 U/L at diagnosis: over one year – 100%; over three years – 66.7%; over five years – 55.6%; and over 10 years – 0% (M=110.977 months; 95% Confidence Interval; 79.915-142.039). The disease-free survival (DFS) indices turned out to be much higher in the group of patients with ALP levels ≤270 U/L: over one year – 91.3%; over five years – 81.6%; and over 10 years – 75% (M=167.507 months; 95% Confidence Interval; 148.185-186.828). Relapses emerged in 18 (62.1%) cases with initially elevated LDH levels, and in nine (64.3%) of 14 cases with T315I mutation. Conclusions. The expression of the BCR::ABL1 transcripts exhibits elevation during the CML recurrence or transformation in the advanced phases. The increased ALP and LDH values demonstrate the activity of CML, and they may be used for asserting the phase at diagnosis confirmation and monitoring under treatment. Positive correlations were observed between BCR::ABL1 transcripts expression and LDH values. The general survival and disease-free survival proved to be higher in CPh-CML patients with lower LDH values at diagnosis and, thus, certified the LDH value as a promising prognostic factor.
Source: Oncolog-Hematolog ro
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7224899405