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-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.

Hodgkin dışı lenfomalı çocukların klinik özelliklerinin, tedavi yaklaşımlarının ve tedavi sonuçlarının değerlendirilmesi

“…Recently, there are studies on the use of some biomarkers such as NLR, PLR, MLR in lymphomas. [5,13,14] Biological markers such as NLR, PLR, and MLR were found to be higher in children with lymphoma compared to children with reactive lymphadenopathy. In multivariate odd ratios of variables for predicting malignancy in all children, the statistical significance of age, extension, hemoglobin and MLR were determined.…”

Inflammatory marker testing in primary care in the year before Hodgkin lymphoma diagnosis: a UK population-based case–control study in patients aged ≤50 years

“…However, the HL disease process itself could also be associated with an inflammatory response (12,13); while this may introduce reverse causality ('protopathic') bias in aetiological studies examining the role of inflammation in HL risk, it could also represent an early marker of as-yetundiagnosed HL, providing potential opportunities for more timely diagnosis.…”

Impact on the survival of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and monocyte-lymphocyte ratio on prognosis in children with Hodgkin lymphoma

“…Furthermore, several studies have highlighted its effects on prognosis in children with malignant diseases. 6,[11][12][13][14][15][16][17][18] In a study carried out on children with reactive lymphadenopathy and children with lymphoma, the lymphoma group's NLR, PLR, and MLR values of children with lymphoma were higher than the reactive lymphadenopathy group. 6 In another study carried out on children with HL, they discovered that NLR was associated with tumor burden and B symptoms.…”

“…These markers include absolute neutrophil counts to absolute lymphocyte counts ratio )NLR(, absolute platelet counts to absolute lymphocyte counts ratio )PLR(, and absolute monocyte counts to absolute lymphocyte counts ratio )MLR( and so on. [6][7][8][9][10][11][12][13][14][15][16][17][18] However, there are few reports on the use of these markers in childhood malignant diseases. Furthermore, several studies have highlighted its effects on prognosis in children with malignant diseases.…”

“…6 In another study carried out on children with HL, they discovered that NLR was associated with tumor burden and B symptoms. 18 This study evaluated the clinical utility of recently described NLR, PLR, and MLR on prognosis in children with HL.…”