The effect of prognostic nutritional index (PNI) on survival and prognosis in newly diagnosed hodgkin lymphoma patients

Introduction: Hodgkin lymphoma (HL) is a B-cell lymphoma characterized by malignant Hodgkin/Reed-Sternberg (HRS) cells. With effective treatment, 80-90% cure rate is achieved. Malnutrition is a common condition in malignancies and may affect patient prognosis. In this study, we evaluated the effect of prognostic nutritional index (PNI) on overall and progression-free survival in newly diagnosed HL patients. Methods: This study was conducted with 214 patients who were followed up with the diagnosis of Hogdkin's Lymphoma in the Hematology Outpatient Clinic of Pamukkale University Faculty of Medicine Hospital since 2013. Age, gender, presence of comorbidities, stage, Hodgkin's lymphoma subtype, bone marrow involvement, presence of extranodal involvement, B symptom, involvement of more than 3 lymph nodes, 1st line treatments given, date of diagnosis, recurrence.line treatments, date of diagnosis, presence-date of relapse, interim evaluation PET-CT and end-of- treatment PET-CT responses, laboratory values at the time of diagnosis (hemoglobin, leukocyte, lymphocyte, eosinophil, basophil, neutrophil, platelet, CRP, ESR, B2- microglobulin, LDH, albumin, fibrinogen and d-dimer levels, if available), date of last visit, date of death data were evaluated. PNI calculated in accordance with the literature with biochemical parameters was used as data. The formula [(Albumin g/L) + (0.005 x LYM 10*3 /uL)] was used for PNI. Overall survival time (OS) and progression-free survival time (PFS) were accepted as primary endpoints. Results: Of the 214 patients with HL evaluated in the study, 66.8% (n=143) were male and 33.2% were female. Low PNI values increase the risk of mortality and progression in patients. In the 5- and 10-year overall survival ROC analysis, the cut- off values for PNI were 46.4 and 48.15. Below these cut-off values, the mortality risk is 5.628 and 5.761 higher (p<0.001). In the 5 and 10-year progression-free survival ROC analysis, the cut-off value for PNI was 48.35. The risk of progression was 2.481 and 2.462 times higher in patients with PNI values below 48.35 (p<0.001). Conclusion: Malnutrition is a factor affecting prognosis in HL patients. PNI may be considered as an effective nutritional parameter on overall survival and progression- free survival in HL patients. More similar studies in HL patients provide more accurate results. Keywords: Hodgkin lymphoma, prognosis, Prognostic nutritional index, overall survival, progression-free survival