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Prognostic Significance of the Ratio of Absolute Neutrophil Count to Absolute Lymphocyte Count in Classic Hodgkin Lymphoma

Young Wha Koh MD, Hyo Jeong Kang MD, Chansik Park MD, Dok Hyun Yoon MD, Shin Kim RN, Cheolwon Suh MD, Ji Eun Kim MD, Chul-Woo Kim MD, Jooryung Huh MD
DOI: http://dx.doi.org/10.1309/AJCPO46GFKGNXCBR 846-854 First published online: 1 December 2012


The aim of this study was to determine the prognostic effect of the absolute neutrophil count/absolute lymphocyte count ratio (ANC/ALC ratio) in patients with classic Hodgkin lymphoma (cHL). We performed a retrospective analysis of 312 patients with cHL. Univariate analysis revealed that a high ANC/ALC ratio (≥4.3) correlated with poor overall survival (OS) (P < .001). Subgroup analysis of advanced-stage disease showed that the ANC/ALC ratio was significant for OS (P = .032). Multivariate analysis revealed the ANC/ALC ratio to be an independent prognostic factor for OS (P = .048). The ANC/ALC ratio allowed further risk stratification in patients who were considered to be at low risk on the basis of an International Prognostic Score less than 4 (P = .002). The ANC/ALC ratio is a simple, inexpensive, and independent prognostic factor for OS that may improve the ability to identify high-risk patients with cHL.

Key Words:
  • Hodgkin lymphoma
  • Neutrophil
  • Lymphocyte
  • Neutrophil/lymphocyte ratio
  • Prognosis

Upon completion of this activity you will be able to:

  • predict prognosis in patients with classic Hodgkin lymphoma using the ratio of absolute neutrophil count to absolute lymphocyte count (ANC/ALC).

  • differentiate a high-risk group among patients who are considered to be at low risk on the basis of an International Prognostic Score <4 using the ANC/ALC ratio.

  • recognize the effect of the ANC/ALC ratio in combination with the ALC to absolute monocyte count ratio for survival prediction of classic Hodgkin lymphoma.

The ASCP is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The ASCP designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ per article. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This activity qualifies as an American Board of Pathology Maintenance of Certification Part II Self-Assessment Module.

The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.

Questions appear on p 905. Exam is located at www.ascp.org/ajcpcme.

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