Pb2261: decrease in neutrophil-lymphocyte ratio impacts overall survival of adult patients with hodgkin lymphoma after anti-pd1 treatment

Topic: 17. Hodgkin lymphoma - Clinical Background: Several prognostic factors have been recognized in early-stage Hodgkin Lymphoma (HL), such as bulky disease or extra-nodal involvement, while for advanced-stage HL an international prognostic scoring system has been defined. More recently there has been increasing interest in the prognostic significance of neutrophil/lymphocyte ratio (NLR), which has already been known to play a role in some solid organ malignancies. Although efficacy and safety of anti-PD1 (Programmed cell death protein 1) inhibitors have changed the landscape of HL treatment, predictors of outcomes in these patients remain to be clarified. Aims: To investigate whether NLR has a prognostic significance in a large real-world cohort of HL patients, with a long follow up. Methods: We included consecutive patients diagnosed with HL between 2001-2020 and received standard treatment according to our Institution’s protocols. The patients’ demographic data, stages at the time of diagnosis (Ann Arbor classification), risk groups, laboratory values, treatment responses, relapse and latest status were recorded. Stages 1 and 2 were defined as early stage, while stages-3 and 4 were defined as advanced stage. Results: We studied 63 HL patients (F: 25, M: 38) with a median age of 31 years (range: 16 – 62). Twenty nine patients were diagnosed at an early stage and 44/63 (69.8%) had the type of nodular sclerosis. All patients received standard chemotherapy with/without radiation according to our Institution’s protocol at the time and their risk classification. Twenty six out of 63 patients had primary refractory disease or relapsed <3 months after the end of treatment. 20 patients relapsed within 12 months after treatment and 17 had a late relapse. Number of lines before autologous hematopoietic cell transplantation (HCT) ranged from 1 to 5. Twenty one patients relapsed or had positive PET/CT scan after auto-HCT and proceeded to either allogeneic HCT (5/21), anti-PD1 treatment (12/21) or other treatment and eventually died (4/21). Low neutrophil count before treatment and decrease of NLR after 3 months of anti-PD-1 treatment was associated with poor OS (p = 0.025). NLR was an independent predictor of lower OS, p= 0.031. On the contrary, decrease of absolute neutrophil count before and after treatment had no impact in OS. With a median follow up at 56.6 months (range: 9 – 239), 9 patients died, 12 are alive with active (stable or relapsed) disease and 42 achieved complete metabolic response. Summary/Conclusion: NLR emerges as a simple and inexpensive independent prognostic factor of survival in patients receiving anti-PD1. Until gene expression profiling becomes available in clinical practice, further studies are needed to confirm the role of NLR as a useful guide for HL patients. Keywords: Lymphoma therapy, Immunotherapy, Hodgkin’s disease, Hematopoietic cell transplantation