Abstract
BackgroundThe neutrophil to lymphocyte ratio (NLR) and the lymphocyte to monocyte ratio (LMR) can reflect both the myeloid dysfunction and T‐cell immune suppression and have prognostic significance.MethodsIn 771 newly diagnosed advanced‐stage Hodgkin Lymphoma (HL) patients we evaluated the baseline values of NLR and LMR as predictors of clinical outcome. According to the multicenter prospective phase II GITIL‐HD0607 trial, all patients received two ABVD courses and if PET‐2 negative received four additional ABVD cycles while if PET‐2‐positive patients were randomized to either BEACOPP escalated (Be) plus BEACOPP baseline (Bb) (4 + 4 courses) or Be + Bb (4 + 4) and Rituximab. PET scans were centrally reviewed by an expert panel by Blinded Independent Central Review.ResultsHigher NLR and lower LMR were associated with a PET‐2 positivity and failure to achieve long‐term disease control, respectively. By univariate and multivariate analysis, large nodal mass (>7 cm), IPS ≥ 3, NLR > 6 were strong independent predictors of early PET‐2 response after ABVD. Only NLR > 6 and IPS ≥ 3 were strong independent predictors of outcome at diagnosis; however, when PET‐2 status was added, only PET‐2‐positive status and IPS ≥ 3 were independent predictors of PFS. Focusing on PET‐2‐negative patients, those with NLR > 6 had an inferior 3‐year PFS compared to patients with NLR ≤ 6 (84% vs 89% months, P = .03).ConclusionIn advanced‐stage HL patients treated with a PET‐2‐driven strategy, IPS ≥ 3 and NLR > 6 are independent predictors of outcome at diagnosis while the presence of large nodal mass, IPS ≥ 3, and NLR > 6 at diagnosis are independent predictors of early ABVD response.
Highlights
Immune accessory cells of the microenvironment play a major part in the development and progression of Hodgkin Lymphoma (HL).[1]
We reviewed the clinical research forms (CRF) of 780 patients with newly diagnosed, advanced-stage HL enrolled in the prospective, open-label randomized phase II trial HD0607 which aimed to improve the 3-year progression-free survival (PFS) of advanced-stage HL patients switching from ABVD to escalated BEACOPP when an early interim PET proved positive.[15]
We show that neutrophil to lymphocyte ratio (NLR) > 6 and, with a minor role, lymphocyte to monocyte ratio (LMR) < 2, calculated at diagnosis, have a negative prognostic meaning in advanced HL treated with a PET-2-dependent approach
Summary
This work was supported by Associazione Italiana per la Ricerca sul Cancro (AIRC), IG n.2013 to AG, by Società Italiana di Ematologia (SIE) to AR, by Associazione Italiana Lotta alla Leucemia (AIL) sezione di Bergamo and sezione di Catania and Università degli Studi di Catania, STARTING GRANT 2020 (AR), fondi di ateneo 2020-2022, linea Open Access.
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