Abstract

BackgroundPrognoses of most adult Hodgkin lymphoma (HL) patients are excellent; most of them can achieve permanent remission that can be considered cured. However, many are under-treated or over-treated by standard modern therapies. An accurate determination of prognosis may allow clinicians to design personalised treatment according to individual risk of disease progression and survival. Lymphocyte monocyte ratio (LMR) at diagnosis has been investigated as a prognostic biomarker in patients with HL. Our objective with this meta-analysis was to explore the prognostic value of the LMR at diagnosis in adult HL, by investigating the association between LMR and survival outcomes.MethodsPUBMED and EMBASE were searched for relevant articles. Survival outcomes that we investigated included overall survival (OS), progression-free survival (PFS), event-free survival (EFS), lymphoma-specific survival (LSS), and time to progression (TTP). No restriction to the language, date, study country, or sample size was applied. Final search of databases was performed on 2 April 2018. We performed random-effects meta-analysis to aggregate and summarise the results from included studies, where four or more studies on a particular outcome were available.ResultsA total of eight studies (all retrospective cohort studies) involving 3319 HL patients were selected for analysis. All studies except one reported the effect of LMR on OS; five reported on PFS, three reported on TTP and LSS, respectively, and one reported on EFS. The pooled estimates showed low LMR was associated with poor OS (hazard ratio [HR] 2.67, 95% CI 1.67, 4.26) and PFS (HR 2.19, 95% CI 1.46, 3.29). Subgroup analyses of OS stratified by LMR cut-off values and sample sizes both indicated that low baseline LMR was associated with poorer prognosis.ConclusionsLow LMR at diagnosis was associated with poor OS and PFS in HL. LMR is easy and cheap to determine and has a potential role in daily clinical management. More studies are needed to validate this biomarker and explore its interaction with known prognostic factors.

Highlights

  • Prognoses of most adult Hodgkin lymphoma (HL) patients are excellent; most of them can achieve permanent remission that can be considered cured

  • This study aims to quantify the relationship between Lymphocyte monocyte ratio (LMR) at diagnosis and survival outcomes in adult HL, and to explore the impact of study characteristics on the prognostic value of LMR, by using meta-analytic techniques

  • In total eight studies involving 3319 HL patients were included in the meta-analysis [51,52,53,54,55,56,57,58]

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Summary

Introduction

Prognoses of most adult Hodgkin lymphoma (HL) patients are excellent; most of them can achieve permanent remission that can be considered cured. It is important at the time of diagnosis to determine the prognosis accurately This allows clinicians to refine and tailor the treatment strategy, to avoid undertreatment (such as inadequate cycles of chemotherapy or exposure to ineffective cytotoxic agents) for patients at higher risk of disease relapse or increased resistance to chemotherapy and radiotherapy, and prevent overtreatment for those with a high chance of having their lymphoma cured, who may be suitable for less toxic therapies [11,12,13]. One study evaluating the outcomes of decreased treatment intensity in a subgroup of early stage HL patients showed that the treatment effectiveness was not compromised when therapy was de-escalated, and more than 50% of all deaths during long-term follow-up were possibly related to the delivered treatment [17]

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