Leukocyte alkaline phosphatase activity in patients with malignant disease

Leukemoid reaction in association with bone marrow necrosis due to metastatic prostate cancer

An 80-year-old man presented to the internist with fever, fatigue and leukocytosis up to 66.8 x 10(3)/microl. Although a chronic myelogenous leukemia was initially suspected, he was diagnosed as metastatic bone marrow tumor with bone marrow necrosis from primary prostate cancer on the basis of the clinical and pathological findings. The serum concentrations of IL-6 and TNF-alpha were mildly elevated to 65.0 pg/ml and, 54.0 pg/ml respectively. It is probable that these humoral factors were partially responsible for the leukemoid reaction although other factors induced by the bone marrow necrosis with bone marrow metastasis of prostate cancer are also likely involved.

Iron, transferrin, and acid and alkaline phosphatase in healthy turkeys and in turkeys inoculated with the lymphoproliferative disease virus

Presented are data on iron-binding capacity determinations in the serum of turkeys infected with lymphoproliferative disease (LPD) virus and in healthy males and females (laying eggs and nonlaying) from a breeding flock. Also presented are results of serum and tissue total acid and alkaline phosphatase determinations in turkey poults infected with LPD virus and their uninfected controls and of serum enzyme levels in healthy males and females from the breeding flock. There was no significant alteration in total iron binding capacity (transferrin level) in the serum of turkeys with LPD. Turkey poults inoculated with LPD virus showed a significant decrease in serum alkaline phosphatase activity 4 and 7 weeks postinfection (pi), and a decrease in serum acid phosphatase activity 7 weeks pi. Acid and alkaline phosphatase activity determined in the spleen and pancreas (organs with pronounced tumor involvement) 7 weeks pi did not differ significantly from that of healthy controls, although there was a tendency for both enzymes to decline in the pancreas of the infected turkeys. Healthy laying female turkeys demonstrated marked elevation in serum transferrin level and in acid and alkaline phosphatase activity, as compared with males of the same age. Serum alkaline phosphatase of turkey poults was markedly higher than that of adult turkeys.

Leukocyte alkaline phosphatase in cancer patient

Leukocyte alkaline phosphatase (LAP) activity in peripheral blood was determined in 113 patients with non-metastatic malignancies, 36 patients with metastatic spread, and 22 individuals who served as controls. The LAP score of the non-metastatic cancer patients was significantly higher (p less than 0.001) than the controls, and the score of the metastatic group was further increased significantly as compared to both control (p less than 0.001) and non-metastatic groups (p less than 0.001). The results of this survey suggest that the level of LAP score in peripheral blood might be used to differentiate between non-metastatic and metastatic disease and might serve as an aid in prognosis of the patients.

Leukocyte alkaline phosphatase in malignancies

The leukocyte alklaine phosphatase (LAP) levels were determined in 183 patients with malignant diseases and 71 normal controls. The median LAP scores were 64 units (range 0 to 290) for the patients and 55 (range 2 to 158) for the controls, respectively, and no significant difference could be established. When analyzed according to primary malignancy, only in patients with Hodgkin's disease (n = 14) was the median value higher than normal (p less than 0.001). In patients with distant metastases (n = 48), higher LAP levels were demonstrated (M = 76, range 21 to 290) as compared to patients with no evidence of metastases (M = 53, range 0 to 229), (p less than 0.01). Thus, LAP activity has very limited value in the diagnosis of malignancies. Its elevation in the presence of malignant disease might, however, indicate metastases.

Comparative study of the endotoxin-stimulated nitroblue tetrazolium test in disease and health

Endotoxin-stimulated nitroblue tetrazolium (NBT) reduction was evaluated in 853 individuals: 270 healthy controls, 334 with various non-neoplastic conditions, 220 with solid non-lymphomatous tumours, and 29 with lymphoma. Each of the above groups was divided into three age subgroups: less than 60, 60-69, and greater than or equal to 70 years. In the controls and in patients with nonmalignant diseases, significantly lower values were recorded for elderly subjects (greater than or equal to 60 years) compared with younger subjects of the same group, whereas in cancer patients the results were independent of age. Under the age of 60, stimulated values for both patient groups were significantly lower than the control values, and in patients with solid non-lymphomatous tumours significantly lower values were attained than in the other patients. NBT reduction in lymphoma patients was comparable to that of the controls. In the elderly (age greater than or equal to 70) no significant differences were noted between patients and controls. It is suggested that stimulated NBT reduction declines with advancing age. While this test clearly demonstrates some leucocyte dysfunction in solid cancer, its value in investigating neutrophil behaviour in elderly subjects is questioned.

Leukocyte alkaline phosphatase

In summary, LAP is an intriguing enzyme and its control is related to pituitary-adrenal function. A review of the changes in LAP activity which occur in some physiological conditions and in disease states has been presented. The function of LAP, however, is unknown. Table I summarizes those conditions in which the LAP is consistently altered enough so to help in the diagnosis of the disorder. Of prime importance is the differentiation of CML from a leukemoid reaction or agnogenic myeloid metaplasia with a leukocytosis. However, in no instance is the LAP value alone diagnostic of any disease. It remains a laboratory test to be utilized in conjunction with all other available clinical data.