title: Neutrophil-lymphocyte ratio at diagnosis is an independent prognostic factor in patients with nodular sclerosis Hodgkin lymphoma: results of a large multicenter study involving 990 patients.
abstract: Several studies have demonstrated the prognostic value of neutrophil-lymphocyte ratio (NLR) in patients with solid tumors and non-Hodgkin lymphoma. In contrast, there is only sparse data on its prognostic role in patients with classical Hodgkin lymphoma (cHL). The aim of our study was to establish whether NLR could serve as an independent prognostic factor in a cohort of 990 patients with nodular sclerosis (NS)-cHL. After analysis of the log hazard ratio (HR) as a function of NLR, we chose the value 6 as cutoff. Patients with NLR >6 had a worse progression-free survival and overall survival compared to those with NLR ≤6; 84% vs 75% and 92% vs 88%, at 5 years, with an HR of 1.65 and 1.82, respectively. Multivariate analysis showed that the risk remained high with HR 1.44 and HR 1.54 in progression-free survival and overall survival, respectively. In summary, our study shows that NLR is a robust and independent prognostic parameter in NS-cHL, both in early and advanced disease. It is inexpensive and simple to apply. Thus, we conclude that NLR, possibly in combination with the international prognostic score and absolute monocyte count, is a useful guide for physicians treating NS-cHL patients.
authors: Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy.
authors: Raffaella
authors: R
authors: Marcheselli
authors: Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy.
authors: Alessia
authors: A
authors: Bari
authors: Hematology-Oncology Unit, Bnai Zion Medical Center, and the Rappaport Faculty of Medicine, Technion, Haifa, Israel.
authors: Tamar
authors: T
authors: Tadmor
authors: Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy.
authors: Luigi
authors: L
authors: Marcheselli
authors: Hematology Unit, Sant'andrea Hospital, Rome, Italy.
authors: Maria Christina
authors: MC
authors: Cox
authors: Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy.
authors: Samantha
authors: S
authors: Pozzi
authors: Hematology Unit, IRCSS, Reggio Emilia, Italy.
authors: Angela
authors: A
authors: Ferrari
authors: Division of Hematology, Fondazione IRCCS Cà Granda, University of Milan, Milan, Italy.
authors: Luca
authors: L
authors: Baldini
authors: Department of Internal Medicine, University of Pavia, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
authors: Paolo
authors: P
authors: Gobbi
authors: Hematology-Oncology Unit, Emek Medical Center, Afula, Israel.
authors: Ariel
authors: A
authors: Aviv
authors: Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy.
authors: Giuseppe
authors: G
authors: Pugliese
authors: Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy.
authors: Massimo
authors: M
authors: Federico
authors: Department of Hematology, Hadassah University, Hospital and Hebrew University Medical School, Jerusalem, Israel.
authors: Aaron
authors: A
authors: Polliack
authors: Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy.
authors: Stefano
authors: S
authors: Sacchi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers; D003131:Combined Modality Therapy; D005260:Female; D006689:Hodgkin Disease / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009504:Neutrophils / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012016:Reference Values; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: Hodgkin lymphoma; lymphocyte; neutrophil; neutrophil-lymphocyte ratio; prognosis