Neutrophil-to-Lymphocyte Ratio and Ferritin as Measurable Tools for Disease Burden and B Symptoms in Pediatric Patients with Hodgkin Lymphoma

Abstract

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.