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Hematol Oncol. 2017 Dec;35(4):561-566. doi: 10.1002/hon.2359. Epub 2016 Oct 28.

Neutrophil-lymphocyte ratio at diagnosis is an independent prognostic factor in patients with nodular sclerosis Hodgkin lymphoma: results of a large multicenter study involving 990 patients.

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Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy.
Hematology-Oncology Unit, Bnai Zion Medical Center, and the Rappaport Faculty of Medicine, Technion, Haifa, Israel.
Hematology Unit, Sant'andrea Hospital, Rome, Italy.
Hematology Unit, IRCSS, Reggio Emilia, Italy.
Division of Hematology, Fondazione IRCCS Cà Granda, University of Milan, Milan, Italy.
Department of Internal Medicine, University of Pavia, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
Hematology-Oncology Unit, Emek Medical Center, Afula, Israel.
Department of Hematology, Hadassah University, Hospital and Hebrew University Medical School, Jerusalem, Israel.


Several studies have demonstrated the prognostic value of neutrophil-lymphocyte ratio (NLR) in patients with solid tumors and non-Hodgkin lymphoma. In contrast, there is only sparse data on its prognostic role in patients with classical Hodgkin lymphoma (cHL). The aim of our study was to establish whether NLR could serve as an independent prognostic factor in a cohort of 990 patients with nodular sclerosis (NS)-cHL. After analysis of the log hazard ratio (HR) as a function of NLR, we chose the value 6 as cutoff. Patients with NLR >6 had a worse progression-free survival and overall survival compared to those with NLR ≤6; 84% vs 75% and 92% vs 88%, at 5 years, with an HR of 1.65 and 1.82, respectively. Multivariate analysis showed that the risk remained high with HR 1.44 and HR 1.54 in progression-free survival and overall survival, respectively. In summary, our study shows that NLR is a robust and independent prognostic parameter in NS-cHL, both in early and advanced disease. It is inexpensive and simple to apply. Thus, we conclude that NLR, possibly in combination with the international prognostic score and absolute monocyte count, is a useful guide for physicians treating NS-cHL patients.


Hodgkin lymphoma; lymphocyte; neutrophil; neutrophil-lymphocyte ratio; prognosis

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