Is the integration of lymphocyte/monocyte ratio and international prognostic score effective in predicting prognosis for hodgkin's lymphoma in the modern era? A prospective cohort study

Abstract

BACKGROUND: Determining the prognosis of Hodgkin's Lymphoma (HL) is crucial to avoid overtreatment and undertreatment, both of which have dangerous effects on the patient's health. This justifies the many studies to find prognostic factors, which in turn contribute to making the appropriate therapeutic decision. International Prognostic Score (IPS) and lymphocyte/monocyte ratio (LMR) are the most common prognostic indicator in HL, but they have some limitations in their application at some stages of the disease. The aim of this research was to study the efficiency of combining IPS and LMR to predict prognosis at both stages of the disease (early and advanced). METHODS: This study included 84 newly classical HL patients treated by ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine) with radiotherapy. RESULTS: IPS showed a poor ability to predict 18-month progression-free survival (PFS) in both early-stage disease (P = 0.162) and advanced-stage disease (P = 0.191); LMR showed high performance in predicting 18-month PFS in early-stage patients treated with ABVD (HR = 5.456, confidence interval [CI] =1.04–28.715, P = 0.045). The combination of IPS and LMR was able to predict 18-month PFS in both early- and advanced-stage disease (HR = 12.21, CI = 1.24–120.1, P = 0.032) (HR = 2.84, CI = 1.04–5.04, P = 0.041), respectively. CONCLUSIONS: The combination of IPS and LMR defines two important risk groups: the high-risk group (IPS ≥3 and LMR <2.9) and the low-risk group (IPS <3 and LMR ≥2.9); it can therefore be used to predict prognosis and adapt treatment to suit each patient's condition.