Early Chemotherapy Response in Patients with Non-Hodgkin Lymphoma Using Baseline Neutrophil–Lymphocyte Ratio as a Predictor in a Nigerian Tertiary Centre
Chiemelie Raluchukwu Onwasigwe *
Department of Haematology and Immunology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria and Department of Haematology and Immunology, Faculty of Basic Clinical Sciences, College of Medicine, University of Nigeria, Enugu State, Nigeria.
Michael Chidiebele Egolum
Department of Haematology and Immunology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.
Angela Ogechukwu Ugwu
Department of Haematology and Immunology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria and Department of Haematology and Immunology, Faculty of Basic Clinical Sciences, College of Medicine, University of Nigeria, Enugu State, Nigeria.
Hector Okechukwu Obianyido
Department of Medical Biochemistry, Faculty of Basic Medical sciences, College of Medicine, University of Nigeria, Enugu Campus, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Background: Non-Hodgkin lymphoma is a heterogeneous group of lymphoid malignancies with variable clinical behaviour and treatment outcomes. In resource-constrained settings, limited access to advanced prognostic investigations increases the need for simple biomarkers. This study evaluated the association between baseline neutrophil-to-lymphocyte ratio and early chemotherapy response in a Nigerian tertiary centre.
Methods: This prospective observational study included 50 consecutive patients with histologically confirmed non-Hodgkin lymphoma at the University of Nigeria Teaching Hospital. Baseline clinical data and full blood count parameters were obtained before chemotherapy. The neutrophil-to-lymphocyte ratio was calculated from absolute neutrophil and lymphocyte counts, and patients were categorised into low (<4.5) and high (≥4.5) groups. All patients received CHOP-based chemotherapy; rituximab was administered to 10 patients based on CD20 positivity, availability and financial considerations. Early response was assessed after three chemotherapy cycles.
Results: The mean age was 47 ± 14 years, and 28 patients (56%) were male. Thirty patients (60%) presented with stage III–IV disease, and 29 (58%) had a high baseline neutrophil-to-lymphocyte ratio. After three cycles, 19 patients (38%) achieved complete response, 18 (36%) had partial response and 13 (26%) had no response. Complete response occurred in 12 of 21 patients (57.1%) with low neutrophil-to-lymphocyte ratio and 7 of 29 patients (24.1%) with high neutrophil-to-lymphocyte ratio. Elevated neutrophil-to-lymphocyte ratio remained associated with poor early response after adjustment for age, stage and rituximab use.
Conclusion: Baseline neutrophil-to-lymphocyte ratio may be an accessible adjunctive marker of early chemotherapy response in patients with non-Hodgkin lymphoma in resource-limited settings.
Keywords: Non-Hodgkin lymphoma, neutrophil-to-lymphocyte ratio, early chemotherapy response, CHOP chemotherapy, rituximab, complete response, prognostic biomarker, systemic inflammation, resource-limited settings, Nigeria