Annals of Hematology

, Volume 97, Issue 6, pp 1009–1018 | Cite as

Prognostic meaning of neutrophil to lymphocyte ratio (NLR) and lymphocyte to monocyte ration (LMR) in newly diagnosed Hodgkin lymphoma patients treated upfront with a PET-2 based strategy

  • Alessandra Romano
  • Nunziatina Laura Parrinello
  • Calogero Vetro
  • Annalisa Chiarenza
  • Claudio Cerchione
  • Massimo Ippolito
  • Giuseppe Alberto Palumbo
  • Francesco Di Raimondo
Original Article


Recent reports identify NLR (the ratio between absolute neutrophils counts, ANC, and absolute lymphocyte count, ALC), as predictor of progression-free survival (PFS) and overall survival (OS) in cancer patients. We retrospectively tested NLR and LMR (the ratio between absolute lymphocyte and monocyte counts) in newly diagnosed Hodgkin lymphoma (HL) patients treated upfront with a PET-2 risk-adapted strategy. NLR and LMR were calculated using records obtained from the complete blood count (CBC) from 180 newly diagnosed HL patients. PFS was evaluated accordingly to Kaplan-Meier method. Higher NLR was associated to advanced stage, increased absolute counts of neutrophils and reduced count of lymphocytes, and markers of systemic inflammation. After a median follow-up of 68 months, PFS at 60 months was 86.6% versus 70.1%, respectively, in patients with NLR ≥ 6 or NLR < 6. Predictors of PFS at 60 months were PET-2 scan (p < 0.0001), NLR ≥ 6.0 (p = 0.02), LMR < 2 (p = 0.048), and ANC (p = 0.0059) in univariate analysis, but only PET-2 was an independent predictor of PFS in multivariate analysis. Advanced-stage patients (N = 119) were treated according to a PET-2 risk-adapted protocol, with an early switch to BEACOPP regimen in case of PET-2 positivity. Despite this strategy, patients with positive PET-2 still had an inferior outcome, with PFS at 60 months of 84.7% versus 40.1% (negative and positive PET-2 patients, respectively, p < 0.0001). Independent predictors of PFS by multivariate analysis were PET-2 status and to a lesser extend NLR in advanced stage, while LMR maintained its significance in early stage. By focusing on PET-2 negative patients, we found that patients with NLR ≥ 6.0 or LMR < 2 had an inferior outcome compared to patients with both ratios above the cutoff (78.7 versus 91.9 months, p = 0.01). We confirm NLR as predictor of PFS in HL patients independently from stage at diagnosis. Integration of PET-2 scan, NLR and LMR can result in a meaningful prognostic system that needs to be further validated in prospective series including patients treated upfront with PET-2 adapted-risk therapy.


PET-2 Hodgkin’s disease NLR LMR 


Funding information

This work was supported by a grant from Ministero della Salute (Ricerca Finalizzata, 10/PE-2011-02350147, F.D.R and N.L.P.) and Fondazione Veronesi (A.R.).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Alessandra Romano
    • 1
    • 2
    • 3
  • Nunziatina Laura Parrinello
    • 2
  • Calogero Vetro
    • 1
    • 2
  • Annalisa Chiarenza
    • 2
  • Claudio Cerchione
    • 4
  • Massimo Ippolito
    • 5
  • Giuseppe Alberto Palumbo
    • 2
  • Francesco Di Raimondo
    • 1
    • 2
  1. 1.Department of General Surgery and Medical-Surgical Specialties, Haematology SectionUniversity of CataniaCataniaItaly
  2. 2.Division of HematologyAOU “Policlinico—Vittorio Emanuele”CataniaItaly
  3. 3.Dipartimento Chirurgia Generale e Specialità Medico-ChirurgicheUniversità degli Studi di CataniaCataniaItaly
  4. 4.Hematology, Department of Clinical MedicineUniversity Federico IINaplesItaly
  5. 5.Nuclear Medicine CenterAzienda Ospedaliera CannizzaroCataniaItaly

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