What is the lymphocyte count in Hodgkin's (Hodgkin) lymphoma?

From the Guidelines

Lymphocyte count in Hodgkin's lymphoma is often decreased, which can be an important diagnostic and prognostic indicator, with lymphopenia commonly observed in patients, particularly those with advanced disease 1.

Key Points

• Lymphopenia (low lymphocyte count) is a common feature of Hodgkin's lymphoma, with counts typically below 1,000 cells/μL in advanced disease.
• The malignant cells in Hodgkin's lymphoma, known as Reed-Sternberg cells, release immunosuppressive cytokines like IL-10 and TGF-β that inhibit normal lymphocyte function and proliferation.
• Lymphocyte count is used in prognostic scoring systems, such as the International Prognostic Score (IPS), where lymphopenia is associated with poorer outcomes.
• Monitoring lymphocyte recovery during treatment is crucial, as persistent lymphopenia after therapy completion may indicate residual disease or immune dysfunction.

Diagnosis and Treatment

• Regular complete blood counts with differential should be performed during diagnosis, treatment, and follow-up to track lymphocyte levels and overall immune function 1.
• The diagnosis of Hodgkin's lymphoma always requires a lymph node biopsy, and the disease is classified into two major subtypes: lymphocyte predominant Hodgkin's lymphoma (LPHL) and classical Hodgkin's lymphoma (cHL) 1.
• Treatment options for Hodgkin's lymphoma have improved significantly over the past few decades, with cure rates now exceeding 80% for many patients, and treatment considerations often focusing on long-term toxicity, especially for patients with early- or intermediate-stage disease 1.

From the Research

Hodgkin's Lymphoma Lymphocyte Count

• The absolute lymphocyte count (ALC) to absolute monocyte count (AMC) ratio (ALC/AMC) is a prognostic factor in Hodgkin lymphoma (HL) 2.
• A low ALC/AMC ratio is associated with established markers of adverse prognosis in HL 2.
• The median ALC/AMC ratio was 2.24 (0.44-20.50) in a study of 537 classical HL patients 2.
• A lower ALC/AMC ratio was associated with a higher risk of recurrence and poorer overall survival in HL patients 2.
• The ALC/AMC ratio had independent prognostic value in multivariate analysis, particularly at a cutoff of 1.1 2.
• However, the prognostically inferior group comprised only 11% of patients, and further research is needed prior to the widespread use of this promising marker 2.

Lymphocyte Count in Hodgkin's Lymphoma Subtypes

• Nodular lymphocyte-predominant HL is a subtype of HL characterized by a distinct disease entity 3, 4, 5, 6.
• Classical HL is another subtype of HL, which includes subgroups such as nodular sclerosis, mixed cellularity, lymphocyte depletion, and lymphocyte-rich HL 3, 4, 5, 6.
• The lymphocyte count may vary in different subtypes of HL, but there is limited information available on this topic 3, 4, 5, 6.

Treatment and Prognosis

• The initial treatment for HL patients is based on the histology of the disease, the anatomical stage, and the presence of poor prognostic features 3, 4, 5, 6.
• Patients with early-stage disease are typically treated with combined modality strategies utilizing abbreviated courses of combination chemotherapy followed by involved-field radiation therapy 3, 4, 5, 6.
• High-dose chemotherapy (HDCT) followed by an autologous stem cell transplant (ASCT) is the standard of care for most patients who relapse following initial therapy 3, 4, 5, 6.