Combined prognostic value of absolute lymphocyte/monocyte ratio in peripheral blood and interim PET/CT results in Hodgkin lymphoma

Abstract

Decreased absolute lymphocyte/monocyte ratio (LMR) in peripheral blood has been reported as an unfavorable prognostic marker in Hodgkin lymphoma. We aimed to investigate whether combining LMR and interim PET/CT scan result (PET2) confers stronger prognostic value than PET2 alone. 121 HL patients were investigated. LMR was calculated from a blood sample taken at the time of diagnosis. PET2 was carried out after the second chemotherapy cycle. Survival was calculated using the Kaplan-Meier method and significance was determined by log-rank test. Effect of variants on survival results was examined using univariate and multivariate analyses. Best LMR cut-off value was determined by receiver operating characteristic (ROC) curve. Best LMR cut-off value was 2.11 in the case of our patients (LMR > 2.11: favorable, LMR ≤ 2.11: unfavorable). Overall and progression-free survivals (OS/PFS) were significantly worse both in lower LMR (≤ 2.11) (OS: P = 0.041, PFS: P = 0.044) and PET2 positive groups (OS: P < 0.001, PFS: P < 0.001). In PET2 positive patient group (n = 32) the low LMR result meant a significantly worse OS (0.030) and PFS (0.001). Both LMR and PET2 proved to be independent prognostic factors on multivariate analysis, and strengthened each other's effect.

Prognostic value of lymphocyte-monocyte ratio at diagnosis in Hodgkin lymphoma: a meta-analysis

“…All except one of these studies reported associations between LMR and OS [51–57]. Five reported on PFS [51, 52, 54, 55, 58], and three reported on TTP [51, 52, 56] and LSS [51–53], respectively. Only one study reported on EFS [57].…”

“…Values having maximum joint sensitivity and specificity were selected. Other potential prognostic factors were investigated in some of the studies, including absolute monocyte count (AMC) [54], positron emission tomography (PET) [55], tumour associated macrophage (TAM) [57], and neutrophil-lymphocyte ratio (NLR) [58]. Some differences in the baseline characteristics such as stage and IPS in the LMR cut-off subgroups were noted in Porrata 2012b et al [52], Koh et al [53], Tadmor et al [54], and Romano et al [58].…”

“…We conducted subgroup analyses by sample size and LMR cut-off value. Four studies had a sample size over 300 [52–54, 56], and four studies had an LMR cut-off value greater than two [51, 53–55].…”

“…5) [51, 52, 54, 55, 58]. All were non-Asian studies [51, 52, 54, 55, 58], three had chosen an LMR cut-off value greater than 2 [51, 54, 55], and two had a sample size larger than 300 [52, 54]. The pooled estimate showed that low LMR was strongly associated with poorer PFS, with HR 2.19 (95% CI 1.46, 3.29, P < 0.001; I 2 = 52.2%; Cochran Q test P = 0.079).…”

The neutrophil to lymphocyte ratio (NLR) and the presence of large nodal mass are independent predictors of early response: A subanalysis of the prospective phase II PET‐2‐adapted HD0607 trial

“…16 High NLR and low LMR have been reported in several retrospective series (Table S1) as negative prognostic factors for both PFS and OS in HL, [26][27][28][29][30][31][32][33][34] but limited data are available in PET-2 era. 6,35,36 Thus, we took advantage of the prospective multicenter phase 2 HD0607 trial to test the clinical meaning of NLR and LMR in patients treated upfront with a risk-adapted strategy, based on a blinded independent central review of PET-2.…”