Albumin metabolism in patients with lymphoma.

Most patients with lymphoma have a reduced serum albumin concentration, often despite adequate nutrition and without evident liver disease or urinary protein loss (1-6). The etiology of this hypoalbuminemia is not clear. Possible causes include dilutional hypoalbuminemia, decreased albumin synthesis, increased albumin catabolism within the body, or excessive loss of albumin from the body through the kidneys or the gastrointestinal tract. Steinfeld (7) studied the metabolism of I131labeled albumin in twelve patients with neoplastic diseases, including one with lymphoma. The survival of albumin was normal or prolonged in these patients, whereas the albumin synthetic rate was reduced. This decreased synthetic rate was felt to be the primary defect leading to the hypoalbuminemia. Jarnum and Schwartz (8), however, demonstrated gastrointestinal protein loss in seven patients with hypoalbuminemia and gastric carcinoma by using I131-labeled polyvinylpyrrolidone. They concluded that this loss of albumin was the cause of the hypoproteinemia seen in their patients and that deficient protein synthesis was not a significant factor. Gastrointestinal protein loss has also been reported in two patients with hypoproteinemia and lymphoma (9, 10). In the present study, albumin metabolism was studied with 1131-albumin in a series of patients with lymphoma to measure the plasma and total body albumin pools, as well as the rate of albumin degradation and synthesis. I131-polyvinylpyrrolidone (PVP) was used to determine if excessive gastrointestinal protein loss was present in these patients.