Aim: To determine the power of the International Prognostic Scoring systems (IPS-7 and IPS-3) and to obtain more explanatory indexes by integrating LLR and PNI as prognostic indicators to IPS in cases with HL.

Patients and Methods: 1,060 patients with HL were included in this study from 8 centers in Turkey. IPS-7 using seven parameters (age, sex, stage hemoglobin, albumin, lymphocyte count, and white cell count) and the modified IPS-3 score with three parameters (stage, age, and hemoglobin level) were calculated. An alternative IPS-4 score with four parameters (stage, age, hemoglobin level, and LLR or PNI) was also calculated. LLR and PNI were integrated to IPSs.

Statistical Analyses: Chi square test or Student t test was used to compare the groups. The cut-off points of this population for the LLR and PNI were evaluated using AUC (area under ROC curve) statistics and median values of the distributions of the variables. Possible alternative cut-off points for the LLR and PNI were evaluated using AUC statistics and median values of the distributions of the variables. For LLR, 5.7 was detected as cut-off point based on ROC analysis and 5.1 based on median. Cut-off for PNI was 45.2 based on ROC analysis and 47.5 based on median. The Kaplan-Meier method and Cox proportional regression model were used to estimate the mean-median overall survival (OS), failure-free survival (FFS) rates, and hazard ratios (HRs). Log-rank test was used to compare the survival distributions between groups. The prognostic ability of parameters was evaluated for OS and FFS in both univariate and multivariate Cox regression models. p value < 0.05 was considered as significant. The analyses were performed using the statistical package SPSS v 22.0.

Results: Female/male ratio was 396/664; mean age was 37.6±15.8 (15-88). About 75% of the patients had stage II-III disease and two thirds of the patient had nodular sclerosis subtype. All factors of IPS-7 and IPS-3 scoring systems were found to be significant factors that related with OS and FFS according to univariate analyses. PNI and LLR were also found to be prognostic factors for OS and FFS. PNI ≤45.2 and LLR ≥5.8 were found to be poor prognostic indicators. Among 7 factors of IPS-7, gender and albumin were not found to be significant according to multivariate Cox regression model. Hence albumin and gender were excluded from the models and PNI and LLR as prognostic factors were added to obtain easier and more explanatory indexes to the model, respectively. Two different Cox regression models were obtained for OS and FFS. Model 1 showed LLR ≥5.8 as the highest risk for OS (OR: 2.7) and Hb <10.5g/dL as the highest risk for FFS (OR: 2.3). Model 2 showed PNI ≤45.2 as the highest risk for OS (OR: 3.2) and Hb <10.5g/dL as the highest risk for FFS (OR: 2.9). Goodness of fit and agreement between IPS-7, IPS-3 groups and IPS-4 groups were found to be acceptable.

Conclusion: IPS-4 score obtained by integrating LLR or PNI to IPS systems can be used as an explanatory index for prognostic indicator in HL.

Citation Format: Semra Paydas, Sahin Lacin, Mutlu Dogan, Ibrahim Barista, Birol Yildiz, Gulsah Seydaoglu, Nuri Karadurmuş, Sinem Civriz, Muhammed Ali Kaplan, Munci Yagci, Emel Gurkan, Vehbi Ercolak. Is it more explanatory to integrate the leukocyte/lymphocyte ratio (LLR) and prognostic nutritional index (PNI) to international prognostic systems (IPS) in cases with Hodgkin lymphoma (HL)? [abstract]. In: Proceedings of the AACR Virtual Meeting: Advances in Malignant Lymphoma; 2020 Aug 17-19. Philadelphia (PA): AACR; Blood Cancer Discov 2020;1(3_Suppl):Abstract nr PO-30.