Abstract
The peripheral blood absolute lymphocyte/monocyte count ratio at diagnosis (ALC/AMC-DX) predicts survival in classical Hodgkin lymphoma (cHL). However, a limitation of the ALC/AMC-DX is the inability to assess sequentially the host/tumor interaction during treatment. Therefore, we retrospectively examined the ALC/AMC ratio, as a surrogate marker of host immunity (ALC) and tumor microenvironment (AMC), at each adriamycin, bleomycin, vinblastine and dacarbazine treatment cycle as a predictor for clinical outcomes. From 1990 until 2008, 190 cHL patients were diagnosed, treated and followed at Mayo Clinic Rochester and qualified for the study. The ALC/AMC ratio at each treatment cycle was a predictor for overall survival (OS) and progression-free survival (PFS). An ALC/AMC ratio ⩾1.1 versus ALC/AMC <1.1 during treatment cycles was an independent predictor for OS (hazard ratio (HR)=0.14; 95% confidence interval (CI): 0.04–0.40; P<0.0002) and for PFS (HR=0.19; 95% CI: 0.05–0.82; P<0.03). The ALC/AMC ratio during treatment cycles is a predictor for survival and provides a platform to develop therapeutic modalities to manipulate the ALC/AMC ratio during chemotherapy to improve clinical outcomes in cHL.
Highlights
The peripheral blood absolute lymphocyte/monocyte count ratio at diagnosis (ALC/AMC-DX) has been recently reported and confirmed to be a predictor for clinical outcomes in classical Hodgkin lymphoma.[1,2] An inverse correlation has been reported between the absolute lymphocyte count (ALC)/AMC-DX and tumor-associated macrophages in cHL, suggesting an association between the host biological response in the macroenvironment and microenvironment.[2]
We studied the ALC/AMC ratio recovery, as a surrogate marker of host immunity and tumor microenvironment, at each treatment cycle phase in patients treated with adriamycin, bleomycin, vinblastine and dacarbazine (ABVD) to assess its predictive ability for clinical outcomes in cHL
Thirteen patients died of causes not related to lymphoma or the treatment of lymphoma, and 14 patients died secondary to relapse/progression of cHL
Summary
The peripheral blood absolute lymphocyte/monocyte count ratio at diagnosis (ALC/AMC-DX) has been recently reported and confirmed to be a predictor for clinical outcomes in classical Hodgkin lymphoma (cHL).[1,2] An inverse correlation has been reported between the ALC/AMC-DX and tumor-associated macrophages in cHL, suggesting an association between the host biological response in the macroenvironment (peripheral blood) and microenvironment (tumor bed).[2]. We studied the ALC/AMC ratio recovery, as a surrogate marker of host immunity (that is, ALC) and tumor microenvironment (that is, AMC), at each treatment cycle phase in patients treated with adriamycin, bleomycin, vinblastine and dacarbazine (ABVD) to assess its predictive ability for clinical outcomes in cHL. No patients refused authorization to use their medical records for research and none were lost to follow-up. Approval for the retrospective review of these patients’ records was obtained from the Mayo Clinic Institutional Review Board, and the research was conducted in accordance with the USA Federal Regulations and the Declaration of Helsinki
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