Method for assessing the effect of antitumor treatment using the leukocyte ratio index in pubertal children with Hodgkinʼs lymphoma

Relevance. Modern advances in risk-adapted chemotherapy allow achieving long-term overall survival in 97.7 % of children with classical Hodgkin lymphoma (cHL), even at widespread stages of the disease. However, relapses and refractory course of cHL are noted in 10 % of cases. In this regard, the search for additional prognostic factors for the course of HL continues.

The aim of the study – to evaluate the significance of using the leukocyte ratio index to assess the effectiveness of antitumor treatment in pubertal children with cHL.

Materials and methods. The study included children of both genders (22 boys and 18 girls) with a morphoimmunohistochemically confirmed diagnosis of cHL. Before treatment and after each course of chemotherapy, the general blood test parameters were determined with subsequent calculation of the leukocyte ratio using the formula: the absolute number of neutrophils was divided by the absolute number of lymphocytes. The results of the study of the leukocyte ratio of 40 conditionally healthy pubertal children in equal sex numbers were used as normal indicators. Statistical processing of the results was performed using the STATISTICA 10.0 program.

Results. In all children with cHL, the leukocyte ratio values exceeded the values of conditionally healthy children from 2.4 to 4.4 times, while there was an increase in the leukocyte ratio by 1.7 times in children with advanced (III, IV) stages of the tumor process compared to stage II. Retrospective analysis of the leukocyte ratio values in children of both genders with HL with remission achieved due to the first line of therapy before treatment demonstrated an increase in the leukocyte ratio by 3.5 times in boys and 4.1 times in girls. At all stages of treatment from the 1^st to the 6^th course, a statistically significant decrease in the studied indicator was revealed compared to the value of the indicator before treatment in boys by an average of 3.6 times, and in girls by an average of 4.3 times. The indicator was within the reference values of the norm. Retrospective analysis of the leukocyte ratio values in adolescent children with refractory and progressive cHL (4 boys and 3 girls) revealed that before treatment, compared to the norm, the average value was 2.6 times higher in boys and 4.2 times higher in girls. Compared with the initial values of the leukocyte ratio in adolescent children with cHL and remission achieved due to the first line of therapy, the data obtained are statistically insignificant. Having analyzed the leukocyte ratio values after each course of polychemotherapy for each patient in particular, it turned out that the indicator statistically significantly increased after those courses in which refractory course or progression of the disease was detected clinically and diagnostically (ultrasound examination, CT, PET/CT). The leukocyte ratio indicator responded by changing the value depending on the effect of subsequent lines of therapy.

Conclusions. In addition to objective instrumental and laboratory methods for assessing the effectiveness of specialized therapy (PET/CT with ¹⁸F-fluorodeoxyglucose, biopsy of the residual neoplasm), as an additional method for assessing the effectiveness of antitumor therapy in pubertal children with cHL, it is also possible to use the leukocyte ratio index based on the results of a complete blood count, which allows indirectly judging the effectiveness of the therapy and timely detection of refractory course or progression of cHL.

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