Tamar Tadmor of the Bnai Zion Medical Center and the Rappaport Faculty of Medicine, Haifa, Israel, and colleagues set out to determine if Absolute Monocyte Count (AMC) and Lymphocyte Monocyte Ratio (LMR) at diagnosis are accurate prognostic indicators in patients with classical Hodgkin Lymphoma (cHL). Their findings were published in Mayo Clinic Proceedings in June 2015.
This retrospective analysis collected clinical and laboratory data between January 1st 1998 and December 31st 2007 from 38 centers in the Gruppo Italiano Studio Linfomi archive and 2 Israeli medical centers after approval by local institutional review boards. A final cohort of 1,450 previously untreated cHL patients was found with a median age of 33 years (17–72), 728 (50%) were males, systemic symptoms were present in 640 (44%) patients, and 1,017 (70%) had Nodular Sclerosis (NS). Evaluating the impact of AMC, Absolute Lymphocyte Count (ALC) and LMR on PFS and OS were the primary end points. Establishing the best cut-off values for AMC and LMR were the secondary end points. With a median follow-up of 87 months:
- Median AMC for all patients = 550 cells/mm3 (2.5th–97.5th percentile, 82–1,527 cells/mm3)
- Best cut-off value for AMC = 750 cells/mm3 (HR, 1.47; 95% CI. 1.17–1.86)
- AMC was higher in patients aged ≥45 years (P=.007) and in patients with a WBC count of >15,000 cells/mm3 (P<.001), NS histology (P<.001), and an IPS of 3–7 (P=.009)
- 5-year PFS = 74% (95% CI, 69–78%) in patients with AMC >750 cells/mm3 (n=359) compared to 81% (95% CI, 79–83%) in patients with AMC ≤750 cells/mm3 (n=1,091; P=.001)
- 5-year OS = 91% (95% CI, 89–92%) in patients with AMC ≤750 cells/mm3 and 86% (95% CI, 82–90%) in patients with AMC >750 cells/mm3 (HR=1.35, 95% CI, 0.99–1.84, P=.06)
- Median ALC for all patients = 1,543 cells/mm3 (2.5th–97.5th percentile, 334–3,981)
- Accepted IPS cut-off value = 600 cells/mm3 for ALC
- Lymphopenia at diagnosis was present in 6% (92) patients
- Median LMR for all patients = 2.8 (2.5th–97.5th percentile, 0.7–17)
- Best cut-off value for LMR = 2.1 (HR=1.49, 95% CI, 1.20–1.86)
- LMR was lower in patients with stage IV disease (P<.001), hemoglobin <10.5g/dL (P<.001), WBC count of 15,000 cells/mm3 (P<.001), albumin level of 4g/dL (P<.001), NS histology (P<.001), and IPS 3–7 (P=.009)
- 5-year PFS = 74% (95% CI, 70–78%) in patients with LMR ≤2.1 (n=493) and 82% (95% CI, 80–85%) in patients with LMR >2.1 (n=957; P=.001)
- OS = 91% (95% CI, 89–92%) and 88% (95% CI, 84–91%) in patients with LMR >2.1 and ≤2.1, respectively (HR=1.29, 95% CI, 0.97–1.72, P=.08)
- In multivariate analysis, both AMC and LMR were significant in terms of prognosis for PFS (HR-1.54, P=.006, and HR=1.50, P=.006) when adjusting for IPS. However, impact on OS was confirmed (HR=1.56, P=.04) only in patients with NS and AMC >750 cells/mm3
The findings of this study validate that AMC predicts prognosis in cHL patients and is particularly significant in patients who present with NS histology.
