Prognostic impact of monocyte percentage and extranodal involvement in classical hodgkin lymphoma: A multicenter real-world study of 547 chinese patients

Classical Hodgkin lymphoma (cHL) has excellent survival outcomes, but real-world data from large-scale cohorts in China remain limited. This multicenter study characterized the clinical profile of a large Chinese cHL cohort to evaluate the efficacy of BV-containing regimens and investigate the prognostic value of clinical, nutritional, and biological markers, including peripheral monocyte percentage (M%). We retrospectively analyzed 547 patients with pathologically confirmed cHL from 10 centers between 2010 and 2023. Clinical characteristics and treatment outcomes were assessed. Propensity score matching (PSM) was employed to minimize selection bias when comparing progression-free survival (PFS) between treatment groups. Multivariate Cox regression models identified independent prognostic factors. The cohort featured a high prevalence of advanced-stage disease (55.0%) and the mixed cellularity subtype (34.4%), distinct from Western populations. While ABVD remained the dominant first-line regimen, the adoption of BV + AVD increased over time. In the PSM analysis, first-line BV + AVD demonstrated a numerically higher 3-year PFS compared with ABVD (95.2% vs. 88.9%), although this difference did not reach statistical significance (P = 0.359). Multivariate analysis identified decreased albumin and elevated M% as independent predictors of inferior PFS, while a focused biological model confirmed elevated M% and bone involvement as independent predictors of inferior overall survival. This study provides comprehensive real-world evidence delineating the clinical landscape of cHL in Chinese patients. While BV + AVD showed a favorable trend toward improved PFS, statistical superiority was not reached, warranting further investigation in larger cohorts. Furthermore, baseline nutritional status (albumin), tumor microenvironment surrogates (M%), and distinct extranodal infiltration (bone involvement) emerged as key prognostic markers, suggesting a need for risk-adapted strategies and potentially intensified therapies in high-risk subgroups.