Prognostic Role of the Red Blood Cell Distribution Width (RDW) in Hodgkin Lymphoma

Ines Herraez,Joan Bargay,Rafael Ramos,Raquel Del Campo,Regina Alemany,Adriana Sas,Leyre Bento,Antonio Gutierrez,Javier Ibarra,Antonia Sampol,Francesc Mestre

doi:10.3390/cancers12113262

Abstract

Simple SummaryThe red blood cell distribution width (RDW) increases in inflammatory conditions and is described as having a prognostic role in different types of cancer. As Hodgkin lymphoma (HL) has a proinflammatory background, we aim to study the prognostic role of RDW in HL. We report in a large retrospective series of homogenously treated HL, for the first time, that RDW is a simple, cheap, and easily available prognostic factor in HL, that identifies a group with worse EFS, OS, and a higher potential incidence of secondary malignancies. RDW seems to be related to most adverse prognostic factors in HL and this may make RDW a good candidate to be included in current or new prognostic scores for HL.The red blood cell distribution width (RDW) is a parameter available from an automated blood count, which measures the degree of heterogeneity of erythrocyte volume and increases in inflammatory conditions. The prognostic role of RDW has been described in different types of cancers. Hodgkin lymphoma (HL) is a hematological malignancy, known to have a proinflammatory background. We aim to study the prognostic role of RDW in HL. We retrospectively analyzed 264 patients with HL from two hospitals in the Balearic Islands between 1990 and 2018. Higher levels of RDW were independently related to anemia, B-symptoms, and low albumin. In age ≥45 years, the presence of lymphopenia and higher RDW were independently associated with worse event-free survival (EFS) and overall survival (OS). Long-term incidence of secondary malignancies was significantly higher in patients with higher RDW, particularly lung cancer. In conclusion, we report for the first time that RDW is a simple, cheap, and easily available prognostic factor in HL that identifies a group with worse EFS, OS, and a higher potential incidence of secondary malignancies. RDW seems to be related to most adverse prognostic factors in HL, making RDW an excellent candidate to be included in prognostic scores for HL.

Highlights

Hodgkin lymphoma (HL) is a hematological malignancy characterized by few neoplastic cells called Reed-Sternberg inside an inflammatory microenvironment [1]
We found that patients with standardized RDW (sRDW) >0.95 were significantly older patients, with more advanced disease, with a higher incidence of B-symptoms, with worse ECOG PS, and several worse adverse prognostic factors such as higher erythrocyte sedimentation rate (ESR), lower albumin levels, lower counts of lymphocytes and low hemoglobin (Hb) levels at diagnosis
We found a relationship with the long-term development of secondary malignancies, a critical adverse prognostic factorin a malignancy such as HL with good long-term survival

Summary

Introduction

Hodgkin lymphoma (HL) is a hematological malignancy characterized by few neoplastic cells called Reed-Sternberg inside an inflammatory microenvironment [1]. Standard therapy regimens cure approximately 80% of patients, but the other 20% will require salvage therapy [2]. The red blood cell distribution width (RDW) is a simple blood test parameter that reflects the size diversity of red blood cells (anisocytosis)in peripheral blood and traditionally was used to study anemias [4]. Higher levels of this parameter have been described as an adverse prognostic factorin cardiovascular diseases, inflammation, and cancer [5,6,7,8,9,10,11]. Higher values of RDW could be associated with a higher degree of inflammation

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