Evaluation of the relationship between the neutrophil/lymphocyte ratio with clinical parameters, prognosis and survival of hodgkin lymphoma and diffuse large b cell lymphoma

Background and aim: Lymphomas are clonal tumors be originating from cells of the immune system, lymphocytes or NK (natural killer) cells. Lymphomas are defined in two main group: hodgkin lymphoma (HL) and non-hodgkin lymphoma (NHL). HL accounts for 1% of all cancers and approximately 25-40% of lymphomas. Diffuse large b-cell lymphoma (DLBCL), the most common subtype of NHLs, is the most common lymphoid malignancy in adults, while the new diagnosis is approximately 20% of the lymphoid malignancies. While The International Prognostic Index (IPI) is used most frequently in determining the prognosis in patients with DBBHL, International Prognostic Score (IPS-7) is used in HL patients. These parameters sometimes may be inefficient in determining the prognosis, because it is difficult to use in daily practice. Therefore, studies are under way to identify simple, inexpensive and easily accessible prognostic biomarkers. Most researchers have considered absolute monocyte counts as a marker of tumor-related macrophages within the tumor microenvironment and absolute neutrophil counts as indicative of the systemic inflammatory response of malignancy while the absolute lymphocyte count is infiltrated by the tumor and considered to be an important marker of lymphocytes involved in the host's immune response. It is suggested that absolute monocyte and lymphocyte counts can be used as an important prognostic factor in HL. Absolute lymphocyte count and neutrophil lymphocyte ratio (NLR) are used as an important prognostic marker for survival in solid tumors, and ın recent years, there have been some reports suggesting that it may be an important prognostic marker in patients with DLBCL. In addition, in a study on patients with DBBHL, the presence of NLR below 3,5 at the time of diagnosis was shown to have a positive effect on the progession-free survival (PS) and overall survival (OS). NLR was associated with poor survival results in various tumors. In our study, we aimed to evaluate the possible relationship of NLR with clinical parameters, prognosis and survival in patients with HL and DLBCL. Materials and Methods: Patients who are above 16 years old were included in the study who were diagnosed, follow-up and treated as HL and DLBCL in Gaziantep University Medical Faculty, Sahinbey Research and Practice Hospital Hematology Clinic between January 2006 and June 2018. Data of 146 patients with HL and 146 patients with DLBCL were obtained and a total of 292 patients were included in the study. Datas are presented retrospectively. The patient's pathologic diagnosis, age at the time of diagnosis and ECOG performance status, life status, gender, follow-up period, stage, reaching the remission with first-line treatment, progression status, overall and progression-free survival of patients, European Organization for the Research and Treatment of Cancer (EORTC) and IPS-7 scores for HL diagnosed patients, IPI score for DLBCL diagnosed patients were obtained. Laboratory parameters were hemoglobin (Hb), leukocyte count (WBC), absolute neutrophil count, absolute lymphocyte count, neutrophil / lymphocyte ratio, erythrocyte sedimentation rate (ESR), albumin C-Reactive Protein (CRP), lactate dehydrogenase (LDH) and beta-2 microglobulin levels were evaluated. Findings: İn patients with DLBCL, advanced age and advanced ECOG performance status were found to be negative independent prognostic factors affecting OS (p<0.001 and p=0.002) and PS (p=0.002 and p=0.002), also high NLR was found to have no effect on OS and PS (p=0,139 ve p=0,333). In patients with HL; advanced age and high NLR were found to be independent prognostic factors affecting OS negatively (p=0,004 ve p=0,014), Also advanced age, high NLR and second line treatment requirement were found to be independent prognostic factors affecting PS negatively (p=0,003, p=0,011 ve p=0,011). Results: It was shown that NLR was an independent risk factor for OS and PS, especially in patients with HL, and that advanced age and advanced ECOG performance status were independent risk factors for OS and PS in patients with DBBHL. It has been concluded that NLR, which has a prognostic value in HL particularly, can be added to risk scoring systems such as EORTC and IPS-7 and as a non-invasive and simple marker, may play a role in the decision of clinical course and aggressive treatment and lead clinician.