title: Absolute Monocyte Count and Lymphocyte-Monocyte Ratio Predict Outcome in Nodular Sclerosis Hodgkin Lymphoma: Evaluation Based on Data From 1450 Patients.
abstract: OBJECTIVE
  To verify whether absolute monocyte count (AMC) and lymphocyte- monocyte ratio (LMR) at diagnosis are valid prognostic parameters in classical Hodgkin lymphoma (cHL).
  
  
  METHODS
  Data were collected from 1450 patients with cHL treated in Israel and Italy from January 1, 1988, through December 31, 2007.
  
  
  RESULTS
  The median age of the patients was 33 years (range, 17-72 years), and 70% (1017) of the patients had nodular sclerosis (NS); the median follow-up duration was 87 months. The best cutoff value for AMC was 750 cells/mm(3), and the best ratio for LMR was 2.1. The adverse prognostic impact of an AMC of more than 750 cells/mm(3) was confirmed for the entire cohort, and its clinical significance was particularly evident in patients with NS histology. The progression-free survival (PFS) at 10 years for an AMC of more than 750 cells/mm(3) was 65% (56%-72%), and the PFS at 10 years for an AMC of 750 cells/mm(3) or less was 81% (76%-84%; P<.001). The overall survival (OS) at 10 years for an AMC of more than 750 cells/mm(3) was 78% (70%-85%), and the OS at 10 years for an AMC of 750 cells/mm(3) or less was 88% (84%-90%; P=.01). In multivariate analysis, both AMC and LMR maintained prognostic significance for PFS (hazard ratio [HR], 1.54, P=.006, and HR, 1.50, P=.006) after adjusting for the international prognostic score, whereas the impact on OS was confirmed (HR, 1.56; P=.04) only in patients with NS and an AMC of more than 750 cells/mm(3).
  
  
  CONCLUSIONS
  This study confirms that AMC has prognostic value in cHL that is particularly significant in patients with NS subtype histology. This finding links the known impact of macrophages and monocytes in Hodgkin lymphoma with routine clinical practice.
authors.affiliation: Hematology-Oncology Unit, Bnai Zion Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion, Haifa, Israel.
authors.forename: Tamar
authors.initials: T
authors.lastname: Tadmor
authors.affiliation: Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Bari
authors.affiliation: Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Marcheselli
authors.affiliation: Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy. Electronic address: stefano.sacchi@unimore.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Sacchi
authors.affiliation: Hematology-Oncology Unit, Emek Medical Center, Afula, Israel.
authors.forename: Ariel
authors.initials: A
authors.lastname: Aviv
authors.affiliation: Division of Hematology, Fondazione IRCCS CàGranda, University of Milano, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Baldini
authors.affiliation: Department of Internal Medicine, University of Pavia, IRCCS San Matteo Hospital Foundation, Pavia, Italy.
authors.forename: Paolo G
authors.initials: PG
authors.lastname: Gobbi
authors.affiliation: Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Samantha
authors.initials: S
authors.lastname: Pozzi
authors.affiliation: Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Ferri
authors.affiliation: Department of Hematology, AO Sant'Andrea, La Sapienza University, Rome, Italy.
authors.forename: Maria Christina
authors.initials: MC
authors.lastname: Cox
authors.affiliation: Hematology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Cascavilla
authors.affiliation: UO di Ematologia, AOUP Paolo Giaccone, Palermo, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Iannitto
authors.affiliation: Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Federico
authors.affiliation: Department of Hematology, Hadassah University Hospital and Hebrew University Medical School, Jerusalem, Israel.
authors.forename: Aaron
authors.initials: A
authors.lastname: Polliack
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006689:Hodgkin Disease / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009000:Monocytes; D011237:Predictive Value of Tests; D011379:Prognosis; D015996:Survival Rate; D055815:Young Adult