title: Peripheral blood lymphocyte/monocyte ratio at diagnosis and survival in classical Hodgkin's lymphoma.
abstract: BACKGROUND
  Lymphopenia and tumor-associated macrophages are negative prognostic factors for survival in classical Hodgkin's lymphoma. We, therefore, studied whether the peripheral blood absolute lymphocyte count/absolute monocyte count ratio at diagnosis affects survival in classical Hodgkin's lymphoma.
  
  
  METHODS
  We studied 476 consecutive patients with classical Hodgkin's lymphoma followed at the Mayo Clinic from 1974 to 2010. Receiver operating characteristic curves and area under the curve were used to determine cut-off values for the absolute lymphocyte count/absolute monocyte count ratio at diagnosis, while proportional hazards models were used to compare survival based on the absolute lymphocyte count/absolute monocyte count ratio at diagnosis.
  
  
  RESULTS
  The median follow-up period was 5.6 years (range, 0.1-33.7 years). An absolute lymphocyte count/absolute monocyte count ratio at diagnosis of 1.1 or more was the best cut-off value for survival with an area under the curve of 0.91 (95% confidence interval, 0.86 to 0.96), a sensitivity of 90% (95% confidence interval, 85% to 96%) and specificity of 79% (95% confidence interval, 73% to 88%). Absolute lymphocyte count/absolute monocyte count ratio at diagnosis was an independent prognostic factor for overall survival (hazard ratio, 0.18; 95% confidence interval, 0.08 to 0.38, P<0.0001); lymphoma-specific survival (hazard ratio, 0.10; 95% confidence interval, 0.04 to 0.25, P<0.0001); progression-free survival (hazard ratio, 0.35; 95% confidence interval, 0.18 to 0.66, P<0.002) and time to progression (hazard ratio, 0.27; 95% confidence interval, 0.17 to 0.57, P<0.0006).
  
  
  CONCLUSIONS
  The ratio of absolute lymphocyte count/absolute monocyte count at diagnosis is an independent prognostic factor for survival and provides a single biomarker to predict clinical outcomes in patients with classical Hodgkin's lymphoma.
authors: Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA. porrata.luis@mayo.edu
authors: Luis F
authors: LF
authors: Porrata
authors: Kay
authors: K
authors: Ristow
authors: Joseph P
authors: JP
authors: Colgan
authors: Thomas M
authors: TM
authors: Habermann
authors: Thomas E
authors: TE
authors: Witzig
authors: David J
authors: DJ
authors: Inwards
authors: Stephen M
authors: SM
authors: Ansell
authors: Ivana N
authors: IN
authors: Micallef
authors: Patrick B
authors: PB
authors: Johnston
authors: Grzegorz S
authors: GS
authors: Nowakowski
authors: Carrie
authors: C
authors: Thompson
authors: Svetomir N
authors: SN
authors: Markovic
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006689:Hodgkin Disease / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D008214:Lymphocytes / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000378:metabolism*; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult