Early interim 2-(1)fluoro-2-deoxy-D-glucose positron emission tomography is prognostically superior to peripheral blood lymphocyte/monocyte ratio at diagnosis in classical Hodgkin's lymphoma

Romano, Alessandra; Vetro, Calogero; Donnarumma, Daniela; Forte, Stefano; Ippolito, Massimo; Raimondo, Francesco Di

doi:10.3324/haematol.2012.064576

Cited by 20 publications

(27 citation statements)

References 10 publications

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“…In contrast to Romano's article [4], the ALC/AMC-DX was found to be an independent of the int-PET to predict PFS and TTP. A difference between Romano's article and this study is that in Romano's study only 9% (11/115) cHL patients presented with an ALC/AMC-DX < 1.1 and in our study it was 21%, suggesting as Romano stated that in difference series, a different cut-off value should be calculated.…”

Section: Discussioncontrasting

confidence: 45%

“…It is important to point out that even though statistical methods are useful to identify cut-off values of new prognostic bio-markers, new bio-markers need to be biologically sound to help us understand and improve clinical outcomes. This current study in addition to our previous publication [1], the studies by Koh [3] and Romano [4] continue to add more information to understand the role of the ALC/AMC-DX on survival in cHL.…”

Section: Discussionmentioning

confidence: 99%

“…Interim PositronEmission Tomography (int-PET), as a functional imaging test for tumor activity, has been shown to be a predictor for progression-free survival (PFS) and time to progression (TTP) in cHL [3]. Romano et al [4] reported that even though the ALC/AMC ratio correlated with prognosis, the int-PET was better discriminator of survival than the ALC/AMC ratio.…”

Section: Introductionmentioning

confidence: 99%

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Absolute Lymphocyte/Monocyte Ratio at Diagnosis and Interim Positron-Emission Tomography Predict Survival in Classical Hodgkin Lymphoma

Porrata¹,

Ristow²,

Habermann³

et al. 2013

JCT

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Interim Positron-Emission Tomography (int-PET) and the peripheral blood absolute lymphocyte/monocyte ratio at diagnosis (ALC/AMC-DX) have been shown to be predictors for progression-free survival (PFS) and time to progression (TTP) in classical Hodgkin lymphoma (cHL). Therefore, we studied if the combination of ALC/AMC-DX and the (int-PET) can further stratified PFS and TTP in cHL patients. Patients were required to be diagnosed, treated, and followed with int-PET at Mayo Clinic, Rochester, Minnesota. From 2000 until 2008, 111 cHL patients qualified for the study. The median follow-up was 2.8 years (range: 0.3 -10.4 years). Patients with a negative int-PET (N = 98) presented with a higher ALC/AMC-DX (median of 2.32, range: 0.26 -37.5) compared with patients with a positive int-PET (N = 13) (median of 0.9, range: 0.29 -3.10), p < 0.004. By multivariate analysis, ALC/AMC-DX and the int-PET were independent predictors for PFS and TTP, when compared with the International prognostic Score. Patients were stratified into four groups: group 1 included patients with a negative int-PET and ALC/AMC-DX ≥ 1.1; group 2 included positive int-PET and ALC/AMC-DX ≥ 1.1; group 3 included negative int-PET and ALC/AMC-DX < 1.1; and group 4 included positive int-PET and ALC/AMC-DX < 1.1. Group 1 experienced superior PFS and TTP in comparison with the other groups. In conclusion, the combination of ALC/AMC-DX and the int-PET provides a simple model to assess clinical outcomes in cHL.

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Section: Discussioncontrasting

confidence: 45%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Absolute Lymphocyte/Monocyte Ratio at Diagnosis and Interim Positron-Emission Tomography Predict Survival in Classical Hodgkin Lymphoma

Porrata¹,

Ristow²,

Habermann³

et al. 2013

JCT

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“…Romano et al [9] concomitantly evaluated ALC/AMC (at the cutoff of 1.1) and the findings of interim positron emission tomography after two cycles of ABVD CT (PET-2), a Lymphocyte/Monocyte Ratio in Hodgkin Lymphoma potent new prognostic biomarker [33,34], in 115 patients with classical HL. There was absolutely no difference in the outcome according to ALC/AMC, whereas a positive PET-2 could clearly differentiate a group with inferior prognosis despite escalation to BEACOPP-based treatment in case of PET-2 positivity.…”

Section: Discussionmentioning

confidence: 99%

“…Koh et al also investigated the role of ALC/AMC in HL and found a much weaker relationship with prognosis in an analysis of 312 patients, using 2.9 as optimal cutoff [7]. Two subsequent studies provided contradictory results, using variable cutoffs [9,10].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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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 × 109/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 × 109/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.

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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

et al. 2020

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Background The neutrophil to lymphocyte ratio (NLR) and the lymphocyte to monocyte ratio (LMR) can reflect both the myeloid dysfunction and T‐cell immune suppression and have prognostic significance. Methods In 771 newly diagnosed advanced‐stage Hodgkin Lymphoma (HL) patients we evaluated the baseline values of NLR and LMR as predictors of clinical outcome. According to the multicenter prospective phase II GITIL‐HD0607 trial, all patients received two ABVD courses and if PET‐2 negative received four additional ABVD cycles while if PET‐2‐positive patients were randomized to either BEACOPP escalated (Be) plus BEACOPP baseline (Bb) (4 + 4 courses) or Be + Bb (4 + 4) and Rituximab. PET scans were centrally reviewed by an expert panel by Blinded Independent Central Review. Results Higher NLR and lower LMR were associated with a PET‐2 positivity and failure to achieve long‐term disease control, respectively. By univariate and multivariate analysis, large nodal mass (>7 cm), IPS ≥ 3, NLR > 6 were strong independent predictors of early PET‐2 response after ABVD. Only NLR > 6 and IPS ≥ 3 were strong independent predictors of outcome at diagnosis; however, when PET‐2 status was added, only PET‐2‐positive status and IPS ≥ 3 were independent predictors of PFS. Focusing on PET‐2‐negative patients, those with NLR > 6 had an inferior 3‐year PFS compared to patients with NLR ≤ 6 (84% vs 89% months, P = .03). Conclusion In advanced‐stage HL patients treated with a PET‐2‐driven strategy, IPS ≥ 3 and NLR > 6 are independent predictors of outcome at diagnosis while the presence of large nodal mass, IPS ≥ 3, and NLR > 6 at diagnosis are independent predictors of early ABVD response.

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Early interim 2-(1)fluoro-2-deoxy-D-glucose positron emission tomography is prognostically superior to peripheral blood lymphocyte/monocyte ratio at diagnosis in classical Hodgkin's lymphoma

Cited by 20 publications

References 10 publications

Absolute Lymphocyte/Monocyte Ratio at Diagnosis and Interim Positron-Emission Tomography Predict Survival in Classical Hodgkin Lymphoma

Absolute Lymphocyte/Monocyte Ratio at Diagnosis and Interim Positron-Emission Tomography Predict Survival in Classical Hodgkin Lymphoma

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

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

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