title: Prognostic Implication of the Absolute Lymphocyte to Absolute Monocyte Count Ratio in Patients With Classical Hodgkin Lymphoma Treated With Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine or Equivalent Regimens.
abstract: Low absolute lymphocyte count (ALC) to absolute monocyte count (AMC) ratio (ALC/AMC) is an independent prognostic factor in Hodgkin lymphoma (HL), but different cutoffs (1.1, 1.5, and 2.9) have been applied. We aimed to validate the prognostic significance of ALC/AMC in 537 homogenously treated (doxorubicin, bleomycin, vinblastine, and dacarbazine or equivalents ± radiotherapy) classical HL patients at various cutoffs. The median ALC/AMC was 2.24 (0.44-20.50). The median AMC was 0.653 × 10(9)/L (0.050-2.070). Lower ALC/AMC was associated with established markers of adverse prognosis. In total, 477 (89%), 418 (78%), and 189 (35%) patients had an ALC/AMC ratio of ≥1.1, ≥1.5, and ≥2.9; respectively; 20% had monocytosis (≥0.9 × 10(9)/L). Ten-year time to progression (TTP) was 77% versus 55% for patients with ALC/AMC ≥1.1 and <1.1 (p = .0002), 76% versus 68% for ALC/AMC ≥1.5 and <1.5 (p = .049), 77% versus 73% for ALC/AMC ≥2.9 and <2.9 (p = .35), and 79% versus 70% for ALC/AMC ≥2.24 and <2.24 (p = .08), respectively. In stages ΙΑ/ΙΙΑ and in patients ≥60 years old, ALC/AMC had no significant effect on TTP. In advanced stages, ALC/AMC was significant only at the cutoff of 1.1 (10-year TTP 67% vs. 48%; p = .016). In younger, advanced-stage patients, the differences were more pronounced. In multivariate analysis of TTP, ALC/AMC < 1.1 (p = .007) and stage IV (p < .001) were independent prognostic factors; ALC/AMC was independent of International Prognostic Score in another model. ALC/AMC was more predictive of overall survival than TTP. At the cutoff of 1.1, ALC/AMC had independent prognostic value in multivariate analysis. However, the prognostically inferior group comprised only 11% of patients. Further research is needed prior to the widespread use of this promising marker.
authors.affiliation: Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece tvassilak@med.uoa.gr.
authors.forename: Theodoros P
authors.initials: TP
authors.lastname: Vassilakopoulos
authors.affiliation: Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Maria N
authors.initials: MN
authors.lastname: Dimopoulou
authors.affiliation: Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Maria K
authors.initials: MK
authors.lastname: Angelopoulou
authors.affiliation: Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Kyriaki
authors.initials: K
authors.lastname: Petevi
authors.affiliation: Athens Medical Center, Psychikon, Athens, Greece.
authors.forename: Gerassimos A
authors.initials: GA
authors.lastname: Pangalis
authors.affiliation: Athens Medical Center, Psychikon, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Moschogiannis
authors.affiliation: First Propedeutic Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Dimou
authors.affiliation: Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Boutsikas
authors.affiliation: Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Kanellopoulos
authors.affiliation: Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Gainaru
authors.affiliation: Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Eleni
authors.initials: E
authors.lastname: Plata
authors.affiliation: Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Pagona
authors.initials: P
authors.lastname: Flevari
authors.affiliation: Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Katerina
authors.initials: K
authors.lastname: Koutsi
authors.affiliation: Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Loula
authors.initials: L
authors.lastname: Papageorgiou
authors.affiliation: Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Vassilios
authors.initials: V
authors.lastname: Telonis
authors.affiliation: Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Panayiotis
authors.initials: P
authors.lastname: Tsaftaridis
authors.affiliation: Athens Medical Center, Psychikon, Athens, Greece.
authors.forename: Sotirios
authors.initials: S
authors.lastname: Sachanas
authors.affiliation: Athens Medical Center, Psychikon, Athens, Greece.
authors.forename: Xanthoula
authors.initials: X
authors.lastname: Yiakoumis
authors.affiliation: Athens Medical Center, Psychikon, Athens, Greece.
authors.forename: Pantelis
authors.initials: P
authors.lastname: Tsirkinidis
authors.affiliation: First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Nora-Athina
authors.initials: NA
authors.lastname: Viniou
authors.affiliation: First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Marina P
authors.initials: MP
authors.lastname: Siakantaris
authors.affiliation: First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Eleni
authors.initials: E
authors.lastname: Variami
authors.affiliation: First Propedeutic Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Kyrtsonis
authors.affiliation: Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Meletis
authors.affiliation: First Propedeutic Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Panayiotis
authors.initials: P
authors.lastname: Panayiotidis
authors.affiliation: Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Kostas
authors.initials: K
authors.lastname: Konstantopoulos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000473:pathology* / Q000532:radiotherapy; D006801:Humans; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000473:pathology*; D008231:Lymphopenia / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000473:pathology*; D012189:Retrospective Studies; D014747:Vinblastine / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D001761:Bleomycin; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin
keywords: Hodgkin's lymphoma; Lymphocyte to monocyte ratio; Lymphocytopenia; Monocytosis; Prognostic factors