Background: Several recent studies have shown the clinical significance of poor nutritional status accessed by Prognostic Nutritional Index (PNI) and Controlling Nutritional status (CONUT) on patients (pts) with solid and hematological malignancies, but its impact on classical Hodgkin lymphoma (cHL) is not established.
Aim: To evaluate the prognostic value of baseline PNI and CONUT in cHL.
Methods: Retrospective analysis of adult pts with cHL, diagnosed between 1990 and 2017 and treated with curative intent with ABVD, escalated BEACOPP or ABVD hybrid regimen and with available data on all PNI variables. The cutoff point for PNI was evaluated using ROC statistics. The association between both scores and progression free survival (PFS) and overall survival (OS) was performed by Cox regression.
Results: 318pts were included, 46.2% male, with median age of 32 (18-80). Of these, 246 (77.3%) had nodular sclerosis and 213 (67%) had advanced stage cHL (GHSG classification). Information on BMI was available for 187pts (median 23.5kg/m2) and 3.2% had BMI<18.5kg/m2. Mean baseline PNI was 47.2 (SD±8.7) and median PFS of 364 months (m). After ROC statistics, the optimal cutoff for PNI to predict 5-year (y) PFS was 47 (Sensibility 36%, Specificity 47%, AUC 0,377). PNI≥47 was significantly associated with an improved PFS (HR 0.42; p<0.001) in univariate analysis, with PFS 5y of 69% for PNI<47 and 82% for PNI≥47. In advanced stages, PNI≥47 retains its prognostic value, even after adjusting for IPS (HR 0.059; p=0.034). After a median follow-up of 145m, median OS was not reached. PNI≥47 was significantly associated with an improved OS (HR 0.35; p<0.001) in univariate analysis but lost its significance in a multivariate model. CONUT was calculated in 191pts (median follow-up 163m), with a median score of 2 (0-9) and most pts with normal/mild risk (86.9%). Higher values of CONUT were associated with poorer PFS (HR 1.13; p=0.040) and OS (HR 1.26; p=0.001), despite its categorization not being a significant predictor of PFS (HR 1.30; p=0.150). The four categories of CONUT were predictors for OS (HR 2.04; p=0.001).
Conclusion: In our cohort, baseline poor nutritional status, calculated with PNI or CONUT, was associated with significantly worse prognosis in cHL. Categorization of CONUT was not a significant predictor of PFS most likely due to a shorter follow-up and fewer pts included. Further external validation of theses scores in cHL is warranted.