CA 125, a New Prognostic Marker for Aggressive NHL.

PURPOSE CA 125 was evaluated in the sera of patients with aggressive NHL, together with LDH and β2m, in a trial to assess its value in the diagnosis and follow-up, and to compare it to some prognostic factors. SUBJECTS AND METHODS The study included 78 newly diagnosed patients with diffuse large B cell non-Hodgkin's lymphoma (DLBCL), with age range 18-60 years, and a WHO performance status of 0, I or II, in addition to twenty apparently healthy controls. All patients received CHOP regimen for 6 cycles. RESULTS The levels of CA 125 and LDH were significantly higher in DLBCL compared to the control group (p-value = 0.031 and = 0.009, respectively). Cutoff levels used were 20U/ml, 310 U/L, and 2mg/l for CA125, LDH and β2m, respectively. CA125 serum level was high in 55%, LDH level in 72%, and β2m level in 62% of patients. As regards the stage, CA 125 was elevated in 17%, 52%, 80%, and 100% of patients in stage I, II, III, and IV, respectively. CA 125 was elevated in 81.3% of patients with bulky disease, in 83.3% presenting with involvement of more than 1 extranodal site, and in 90% presenting with effusion. The highest levels of CA125, LDH, and β2m were observed in stage IV, and lowest in stage I (p-value<0.001, 0.005, and 0.154, respectively). There was also a significant positive correlation between CA 125 and LDH (p-value <0.001). CA 125 showed specificity of 80% with 95% CI (56- 94), and LDH showed sensitivity of 72% with 95% CI (60-81). Complete response to treatment was achieved in 71.8% of our patients. Survival at 24 months was 78.2%. There was a statistically significant increase in survival in patients with CA125<20U/ml, patients with LDH<310U/L, and patients with β2m<2mg/l (p-value = 0.006, 0.025, and 0.042, respectively). A shorter disease-free survival was associated with increased CA 125 (p<0.001). CONCLUSION CA125 was found to correlate with stage, tumor bulk, involvement of more than 1 extranodal site, and presence of effusion. Elevated levels of CA 125 and LDH were found to predict decreased survival. Initial measurement of CA125 may, therefore, provide valuable prognostic information. KEY WORDS CA125 - LDH - β2m, NHL - DLBCL.