Serum alkaline phosphatase at the onset of Hodgkin's disease

Serum alkaline phosphatase levels have been studied in 111 patients at the onset of Hodgkin's disease. With advancing stage there was a progressive increase in the percentage of patients with elevated enzyme: 14 percent in Stages I and II, 65 percent in Stage III, and 81 percent in Stage IV. In all stages there was a very high incidence of elevated phosphatase in patients with fever but not in those with only pruritus, suggesting a different pathogenesis of the 2 complaints. The source of the elevated serum enzyme was analyzed in 31 patients by electrophoresis on polyacrylamide gel. The liver enzyme was elevated in 23 individuals, the bone enzyme in 3, both in 2, and, in 3 individuals, it was not possible to state which enzyme was elevated. Elevations of hepatic phosphatase were by far the most important cause of serum alkaline phosphatase elevation at the onset of Hodgkin's disease. Increase of this isozyme caused almost all the elevations analyzed in patients presenting with advanced disease: all those in Stages IIIB and IVB, and all but 2 in Stage IIIA. While the majority of such increases were felt to be the result of hepatic lymphoma, several instances of a reversible liver isozyme elevation associated with fever and negative open liver biopsy were encountered. Bromsulphalein retention was more frequently abnormal than the 5′-nucleotidase values in individuals with elevated liver phosphatase. The infrequent elevations of bone phosphatase were usually seen in individuals with localized Stage I and II Hodgkin's disease (5 of 8 instances) who were below' the age of 21 (7 of 8 instances). Two of the 3 such elevations observed over an extended period of time returned to normal. It was felt that the bone isozyme elevation in these young patients was usually physiologic representing late adolescent bone growth, and that osseous lymphoma was an uncommon cause of alkaline phosphatase elevation at the onset of Hodgkin's disease.