Journal
ONCOLOGIST
Volume 21, Issue 3, Pages 343-353Publisher
WILEY
DOI: 10.1634/theoncologist.2015-0251
Keywords
Hodgkin's lymphoma; Lymphocyte to monocyte ratio; Lymphocytopenia; Monocytosis; Prognostic factors
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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 x 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% hadmonocytosis (>= 0.9x10(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 IA/IIA 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. Inmultivariate 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.
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