Prognostic role of the neutrophil-to-lymphocyte ratio in pediatric Hodgkin lymphoma: insights from a 20-year single-center experience

INTRODUCTION: The neutrophil-to-lymphocyte ratio (NLR) is an established prognostic marker in adult malignancies, including Hodgkin lymphoma (HL). However, its clinical significance in pediatric HL remains uncertain due to biological differences and generally favorable outcomes. This study aimed to evaluate the prognostic value of the diagnostic NLR in predicting relapse, refractory disease, and mortality in children with HL. MATERIALS AND METHODS: Eighty-two patients under 18 years of age who were diagnosed with HL between 2005 and 2025 were retrospectively analyzed. Clinical features, laboratory parameters, treatment response, and survival outcomes were assessed. The NLR was calculated from baseline blood counts obtained before therapy. Receiver operating characteristic (ROC) curve analysis, Kaplan-Meier survival estimates, and logistic regression models were used to determine the prognostic performance of the NLR alongside conventional factors such as stage, B symptoms, albumin, and the erythrocyte sedimentation rate. RESULTS: The mean NLR at diagnosis was 3.76 ± 2.77. ROC analysis revealed poor discriminative power (AUC = 0.517, p = 0.822). Event-free survival (EFS) and overall survival (OS) did not differ between the high and low NLR groups (p = 0.870 and p = 0.315, respectively). In the multivariable logistic regression, early two-cycle chemotherapy response remained an independent predictor of adverse outcomes (p = 0.002), whereas bulky disease showed borderline significance (p = 0.059). The NLR and other inflammatory markers, including the ESR and albumin, were not associated with poor prognosis. CONCLUSION: The diagnostic NLR lacks independent prognostic value in this pediatric HL cohort. These findings highlight the biological distinctness of pediatric disease and suggest that adult-derived inflammatory biomarkers should not be directly extrapolated to childhood malignancies.