Background: Pediatric Hodgkin lymphoma (HL) has been treated successfully with risk-adapted and response-adapted therapy. While risk factors like Ann Arbor staging system, B symptoms, bulky disease, and erythrocyte sedimentation rate were measured objectively, B symptoms are subjective tools. We evaluated whether the neutrophil-to-lymphocyte ratio (NLR) and inflammatory marker levels correlated with B symptoms and disease burden.Materials and Methods: We conducted a retrospective chart review of all children ≤ 14 years old with pathology-confirmed HL treated at our institution. Data included clinical and pathologic features, pretreatment erythrocyte sedimentation rate, ferritin levels; monocyte, neutrophil, and lymphocyte counts; and NLR. Optimum cutoffs of variables significantly associated with B symptoms were determined based on receiver operating characteristic curves.Results: Sixty-four patients were included in the analysis. Sixteen patients (25%) had B symptoms. Patients with B symptoms had higher ferritin levels (P < 0.0001), monocyte counts (P = 0.0060), neutrophil counts (P = 0.0003) and NLR (P < 0.0001), and lower lymphocyte counts (P = 0.0017). Multiple receiver operating characteristic curves were generated to identify the optimum cutoff. Sensitivities and specificities of NLR (cutoff, 3.5) and ferritin (cutoff, 173 ng/mL) were the highest (81.25% and 81.25% [P < 0.0001] and 89.36% and 75% [P < 0.0001], respectively). Patients with NLR > 3.5 and ferritin > 173 (ng/mL) had significantly higher stage, bulky disease, and B symptoms. NLR and ferritin are not predictive of worst outcome in the cohort analyzed.Conclusions: NLR and ferritin levels were associated with high disease burden and B symptoms. Therefore, these variables can be used as measurable tools for B symptoms that can help stratify patients with HL. Larger and prospective studies are needed to validate these findings.
Background Pediatric Hodgkin lymphoma (HL) has been treated successfully with risk- and response-adapted therapy. While all these risk factors are measured objectively, B symptoms are subjective tools. We evaluated whether the neutrophil-to-lymphocyte ratio (NLR) and inflammatory marker levels correlated with B symptoms and disease burden. Methods The medical charts of all children ≤14 years old with HL were retrospectively reviewed. Data included, clinical and pathological features, pretreatment ESR, ferritin levels; monocyte, neutrophil, and lymphocyte counts; and NLR. Optimum cutoffs of variables significantly associated with B symptoms were determined based on receiver operating characteristic curves. Results Sixty-four patients were included in the analysis. Sixteen patients (25%) had B symptoms. Patients with B symptoms had higher ferritin levels (p<0.0001), monocyte counts (p=0.0060), neutrophil counts (p=0.0003) and NLR (p <0.0001) and lower lymphocyte counts (p=0.0017). Multiple ROC curves were generated to identify the optimum cut-off. The sensitivities and specificities of NLR (cut-off, 3.5) and ferritin (cut-off, 173 ng/ml) were highest [81.25% and 81.25% (p<0.0001) and 89.36% and 75% (p<0.0001), respectively]. Patients with NLR >3.5 and ferritin>173 (ng/ml) had significantly higher stage, bulky disease, and B symptoms. There was no association between NLR and ferritin with disease outcome. Conclusions NLR and ferritin levels were associated with high disease burden and B symptoms. Therefore, these variables can be used as measurable tools for B symptoms that can help stratify patients with HL. Larger and prospective studies are needed to validate these findings.
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