Can white blood cell count ratios help predict outcomes for newly diagnosed HL patients receiving PET2-mediated treatment?

This study investigated the impact of white blood cell counts on the outcomes of newly diagnosed Hodgkin’s lymphoma (HL) patients receiving treatment mediated by PET2 (PET scanning after 2 cycles of chemotherapy). This study concluded that ratios of different types of white blood cells combined with PET2 can be a meaningful prognostic tool for HL patients.

FDG PET scanning during chemotherapy treatment is used to guide early treatment for new Hodgkin’s lymphoma (HL) patients. Depending on the scan results, treatment can be decreased, increased, or changed to a different therapy. For example, patients with limited disease may show negative scan results, which could lead to their treatment being decreased. This makes it easier to identify patients who can achieve better outcomes with less therapy or who need their therapies changed.

PET2 is PET scanning performed early after the first two cycles of chemotherapy. PET2 has been shown to be the most reliable tool to predict treatment outcomes and adapt treatment strategies for patients. NLR (neutrophil-lymphocyte ratio) and LMR (lymphocyte-monocyte ratio) are ratios of white blood cell counts. These ratios have been shown to predict survival outcomes for cancer patients. However, the impact of these ratios with PET2 on patient outcomes remains unclear for HL.

This study involved information from the records of 180 patients with newly diagnosed HL. 34% of patients had early-stage (I – IIA) disease, and 66% of patients had late-stage (IIB – IV) disease. All patients received ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) chemotherapy and radiotherapy. PET2-positive patients also received BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) chemotherapy. Patients with persistent disease also received autoSCT (autologous stem cell transplant). The average follow-up period was 68 months.

After 2 cycles of ABVD chemotherapy, 14% of patients had positive PET2 results. Positive PET2 was significantly associated with a lower average LMR (1.7) and a higher average NLR (7.4) compared to negative PET2 (2.3 LMR, 4.8 NLR). 

The 5-year progression-free survival (PFS; time from treatment before disease progression) was 79.8% for all patients. Patients with a lower NLR had a significantly higher PFS (86.6%) compared to patients who did not (PFS 70.1%). Patients with a higher LMR had a significantly higher PFS (87.7%) compared to patients who did not (PFS 70.2%). A high NLR and low LMR were associated with a PFS of 78.7%. A low NLR and high LMR were associated with a PFS of 91.9%. These differences were statistically significant.

This study concluded that NLR and LMR combined with PET2 can be a meaningful prognostic tool for HL patients. The authors found that high NLR is associated with an increased risk of treatment failure in advanced stage HL, while high LMR shows this trend for early-stage patients.

This study looked back in time to analyze patient files. As a result, the collected data may be incomplete. The usefulness of NLR and LMR ratios needs to be further confirmed in multicenter studies with PET2-negative HL patients.