D. Neves, A. Roque, C. Afonso, A. Pinto, D. Mota, R. Guilherme, M. Gomes, L. Ribeiro
Clinical Hematology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
Background: Classical Hodgkin lymphoma (cHL) has a long-term outcome under standardized treatment. However, about 25% of the patients (pts) will experience relapse or be refractory to the initial therapy. Prognostic biomarkers might help identify this risk population. Different studies have analysed peripheral blood white cell count as promising biomarkers with no well-established conclusion.
Aims: Analyse the impact of peripheral blood absolute neutrophil/monocyte count ratio (NMR), lymphocyte/monocyte count ratio (LMR) and platelet/monocyte count ratio (PMR) at diagnosis in progression free survival (PFS) and overall survival (OS) in cHL.
Methods: We perform a retrospective analysis of cHL pts treated in our institution, between 1990 and 2017. The best cut-off point was stipulated as 15.9 for NMR, 1.9 for LMR and 633.7 for PMR, by using receiver operating characteristic (ROC) curves.
Results: We included 303 pts, mainly female (53.1%), with a median age at diagnosis of 33 years (yrs) (18–80). Nodular sclerosis subtype was predominant (76.2%). Considering the GHSG, 13.5% (n = 41) had early stage disease and 48.2% (n = 146) advanced stage.
All ratios - NMR (HR 1.02; p = 0.028), LMR (HR 1.06; p = 0.044), and PMR (HR 1.001; p = 0.001) - demonstrated a directly relation with mortality.
NMR≥15.9 was associated with lower 5y OS (78.2 vs 88.3%) (HR 2.00; p = 0.008). LMR ≥ 1.9 and PMR ≥ 633.7 failed to have a significant discriminative relevance for OS (HR 0.70; p = NS and HR 1.41; p = NS, respectively).
The reported cut-off points did not have a statistical significant association with PFS.
We examined whether these ratios were related with some established prognostic factors. A LMR ≥ 1.9 was negatively associated with the presence of B symptoms (OR 0.37; p < 0.001) and bulky mass (OR 0.45; p = 0.002) at diagnosis.
A NMR≥15.9 was associated with haemoglobin < 10.5 g/L (OR 2.13; p = 0.028) and hypoalbuminemia (OR 1.80; p = 0.044), while LMR ≥ 1.9 was associated with the absence of anaemia (OR 0.43; p = 0.007) and normal serum albumin (OR 0.43; p < 0.001).
LMR≥1.9 showed to be inversely related with advanced GHSG stages (OR 0.36; p < 0.001).
Conclusion: Our results suggest that NMR can be a readily available positive predictor of mortality when applied at diagnosis, while an increased LMR was associated with the absence of bad prognosis factors.
We failed to find the reported prognostic relevance for PFS with the published ratios.