Neutrophil-to-Lymphocyte Ratio and Ferritin as Measurable Tools for Disease Burden and B Symptoms in Pediatric Patients With Hodgkin Lymphoma

Evaluation of clinical features, treatment approaches and treatment outcomes of children with non-Hodgkin lymphoma

Aim: To evaluate the demographic and clinical characteristics, treatment approaches and outcomes of our pediatric patients with non-Hodgkin lymphoma diagnosed and treated in our center. Material and Methods: Between 2006 and 2002, the oncologic charts of the patients diagnosed and followed up as non-Hodgkin lymphoma were reviewed retrospectively. Results: Eighty children with non-Hodgkin lymphoma were included in this study. There were 55 boys (68.8%) and 25 girls (31.2%). The patients’ ages ranged from 2 to 18 years (median: 11.1 years). Nine patients (11.3%) had primary immunodeficiency. Sixty-three of the patients were stage III (78.7%). The majority pathologic subtype was Burkitt lymphoma (n: 31, 38.8%). The overall survival and event-free survival rates were 71.7% and 71.5%, respectively. The patients’ overall survival rates without and with primary immunodeficiency was 81.1% and 11.1%, respectively. There was a significant difference between these two groups. Cox regression analysis showed that advanced stage and concomitant primary immunodeficiency have been risk factors for prognosis. Conclusion: Intensive treatment approaches have increased overall survival rates in children with non-Hodgkin lymphoma. However, this success rate cannot be achieved in non-Hodgkin lymphoma children with primary immunodeficiency.

Inflammatory marker testing in primary care in the year before Hodgkin lymphoma diagnosis: a UK population-based case-control study in patients aged ≤50 years

BACKGROUND

Proinflammatory conditions are associated with increased risk of Hodgkin lymphoma, although the neoplastic process per se often induces an inflammatory response.

AIM

To examine pre-diagnostic inflammatory marker test use to identify changes that may define a 'diagnostic window' for potential earlier diagnosis.

DESIGN AND SETTING

This was a matched case-control study in UK primary care using Clinical Practice Research Datalink data (2002-2016).

METHOD

Primary care inflammatory marker test use and related findings were analysed in 839 Hodgkin lymphoma patients and 5035 controls in the year pre-diagnosis. Poisson regression models were used to calculate monthly testing rates to examine changes over time in test use. Longitudinal trends in test results and the presence/absence of 'red-flag' symptoms were examined.

RESULTS

In patients with Hodgkin lymphoma, 70.8% (594/839) had an inflammatory marker test in the year pre-diagnosis versus 16.2% (816/5035) of controls (odds ratio 13.7, 95% CI = 11.4 to 16.5, P<0.001). The rate of inflammatory marker testing and mean levels of certain inflammatory marker results increased progressively during the year pre-diagnosis in Hodgkin lymphoma patients while remaining stable in controls. Among patients with Hodgkin lymphoma with a pre-diagnostic test, two-thirds (69.5%, 413/594) had an abnormal result and, among these, 42.6% (176/413) had no other 'red-flag' presenting symptom/sign.

CONCLUSION

Increases in inflammatory marker requests and abnormal results occur in many patients with Hodgkin lymphoma several months pre-diagnosis, suggesting this period should be excluded in aetiological studies examining inflammation in Hodgkin lymphoma development, and that a diagnostic time window of appreciable length exists in many patients with Hodgkin lymphoma, many of whom have no other red-flag features.