The red blood cell distribution width (RDW) is a parameter available from an automated blood count, which measures the degree of heterogeneity of erythrocyte volume and increases in inflammatory conditions. The prognostic role of RDW has been described in different types of cancers. Hodgkin lymphoma (HL) is a hematological malignancy, known to have a proinflammatory background. We aim to study the prognostic role of RDW in HL. We retrospectively analyzed 264 patients with HL from two hospitals in the Balearic Islands between 1990 and 2018. Higher levels of RDW were independently related to anemia, B-symptoms, and low albumin. In age ≥45 years, the presence of lymphopenia and higher RDW were independently associated with worse event-free survival (EFS) and overall survival (OS). Long-term incidence of secondary malignancies was significantly higher in patients with higher RDW, particularly lung cancer. In conclusion, we report for the first time that RDW is a simple, cheap, and easily available prognostic factor in HL that identifies a group with worse EFS, OS, and a higher potential incidence of secondary malignancies. RDW seems to be related to most adverse prognostic factors in HL, making RDW an excellent candidate to be included in prognostic scores for HL.

Hodgkin lymphoma (HL) is a hematological malignancy with an excellent prognosis. However, we still need to identify those patients that could experience failed standard frontline chemotherapy. Tumor burden evaluation and standard decisions are based on Ann Arbor (AA) staging, but this approach may be insufficient in predicting outcomes. We aim to study new ways to assess tumor burden through volume-based PET parameters to improve the risk assessment of HL patients. We retrospectively analyzed 101 patients with HL from two hospitals in the Balearic Islands between 2011 and 2018. Higher metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were significantly associated with a higher incidence of III-IV AA stages, B-symptoms, hypoalbuminemia, lymphopenia, and higher IPS. Standardized uptake value (SUVmax) was significantly related to AA stage and hypoalbuminemia. We found that TLG or the combination of SUVmax, TLG, and MTV significantly improved the risk assessment when compared to AA staging. We conclude that TLG is the best single PET/CT-related tumor-load parameter that significantly improves HL risk assessment when compared to AA staging. If confirmed in a larger and validated sample, this information could be used to modify standard frontline therapy and justifies the inclusion of TLG inside an HL prognostic score.

Red cell distribution width (RDW) is an indicator of the variability in the size of circulating erythrocytes (anisocytosis); different conditions can increase the RDW levels; such as hemolysis, ineffective erythropoiesis and blood transfusions. Recently, different studies have shown an association between increased levels of RDW and inflammation in different diseases, being proposed as a surrogate marker of inflammation and astrong predictor of adverse outcome. The proposed mechanism of this association departs from the finding that Inflammatory cytokines like TNFand IL-6 (part of the classic inflammatory cascade), have been found to inhibit erythropoietin-induced erythrocyte maturation, which is reflected in the RDW increase. Hodgkin lymphoma (HL) is a B cell neoplasm which originates in the germinal or post-germinal center B cells and is characterized by the presence of clonal malignantHodgkin/Reed-Sternbergcells (HRS) in an inflammatory background. The presence of autocrine or paracrine cytokines signaling loops drive proliferation and survival of HRS cells, making HL a lymphoma where the inflammatory status is important. We aim to evaluate the prognostic role of RDW levels in HL patients at diagnosis. METHODS We retrospectively evaluated 119 patients with HL homogenously treated in frontline with ABVD from 2001 to 2015 in the Son Espases University Hospital. To avoid selection bias patients were obtained from Pharmacy and Pathology Departments registries. Main clinical and prognostic factors at diagnosis were obtained from medical records. Cheson criteria were used for response assessment. The RDW was collected from the hemogram at diagnosis. The IBM SPSS STADISTICS program was used for all statistical analyses. PFS (time to progression/relapse) and overall survival (OS) (time to death) were measured from the date of ABVD onset, and were estimated according to the Kaplan-Meier method. We performed the comparisons between those interest variables with the log-rank test. A comparison between categorical variables was made with the chi-square of Fisher's exact test, as appropriate. All reported P-values were two-sided, and statistical significance was defined at P1, 47% advanced III-IV Ann Arbor (AA) stage, 42% B-symptoms and 29% IPS>2 Median RDW was14.1 (11-23.9).Using ROC curves we selected the cutoff 16.6 for relapse/progression event. We evaluated the association of increased RDW with main prognostic factors at diagnosis. RDW >16.6 at diagnosis was associated with a worse ECOG PS, a more advanced AA stage, higher incidence of B symptoms, IPS>2, higher Erythrocyte sedimentation rate (ESR) and unfavorable lymphocyte/monocyte rate (LMR) (Table 1). Patients with RDW>16.6 were associated with worse responses compared to those with RDW≤16.6: 29% versus 6% of stable/progressive disease and lower complete or partial responses: 67% and 5% versus 93% and 1%, respectively (p=0.004). Univariate survival analysis is shown in Table 2. Age, ECOG PS, AA stage, IPS, LMR and RDW were related to PFS. Age, ECOG PS, IPS and LMR were associated with OS. Multivariate analysis showed age>60 years (HR 7.66; p=0.002), RDW>16.6 (HR=3.41; p=0.005) and advanced AA stage (HR=2.55;p=0.044) as independently associated to worse PFS (Figure 1) while only age>60 years (HR=11.5; p1 (HR=4.15; p=0.008) independently influenced a worse OS. CONCLUSION: Higher RDW at diagnosis was related with more aggressive and advanced disease in HL and lower response rates, probably reflecting a higher inflammatory activity of the lymphoma and its microenvironment. RDW>16.6 was independently associated with a worse PFS.

Hodgkin lymphoma (HL) is a highly-curable malignancy mostly affecting young people. As far as we know, there is no published study that has analyzed personality profiles in HL nor their potential role in lymphomagenesis, natural history, or response to treatment. We aim to explore the personality traits of HL patients, as well as the prevalence of mental disorders and suicide ideas. We retrospectively identified all alive HL patients from three centers (Son Espases and Son Llatzer University Hospitals and Hospital del Mar of Barcelona) for using NEO Five-Factor Inventory (NEO-FFI) and Personality Inventory for DSM-5 Brief Form. Patients with HL showed significantly higher neuroticism scores and lower conscientiousness, extraversion, and openness. Considering maladaptive personality traits, HL patients showed higher levels of detachment and psychoticism. All of these translated into the fact that HL patients showed more than double the prevalence of mental illnesses (41%) and more than triple the prevalence of suicidal ideation or attempts than the general population (15 and 6%, respectively). An exploratory analysis of biomarkers associated with HL personality traits showed that higher scores of neuroticism correlated with more elevated erythrocyte sedimentation rate (ESR) and red cell distribution width (RDW), suggesting a potential link between neuroticism and proinflammatory activity in HL.

Background DLBCL is the more common non Hodgkin lymphoma. This is an aggressive lymphoma that is treated with a standard chemotherapy regimen: R-CHOP. In the last years attempts have been done to improve the outcome both increasing dose-density (DD) (CHOP14) or intensity (CHOEP, ACVBP, frontline high dose therapy followed by autologous stem cell transplantation). Although phase 2 studies of these interventions suggested promising results, when randomized phase 3 trials have been conducted, there is no demonstrated benefit of these higher toxicity approaches when compared with R-CHOP alone. Only addition of rituximab to CHOP has proved a survival advantage. This has allowed setting R-CHOP administered every 21 days (R-CHOP21) as the standard treatment for DLBCL patients. The purpose of this study is further analyzing the prognostic impact of DD delays in two cohorts of DLBCL patients treated with R-CHOP21 or R-CHOP14. Methods All patients diagnosed between 1999 and 2013 of DLBCL in University Hospital Son Espases were identified from Pathology Department registry. Only patients treated with R-CHOP21 or R-CHOP14 +/- radiotherapy were included. Patients receiving other chemotherapy regimens or consolidations were excluded. DD delay was calculated as follows: DD delay = real number of days from first to last cycle of chemotherapy / expected number of days from first to last cycle in every regimen. Results A total of 166 cases were identified: considering inclusion and exclusion criteria finally 111 cases were selected (71 in the R-CHOP21 cohort and 40 in the R-CHOP14 cohort). Respectively for R-CHOP21 and R-CHOP14, 61% and 37% were older than 60 years (p=0.02), 26% and 35% had an ECOG PS higher than 1 (p=0.3), 49% and 62% had an Ann Arbor stage III-IV (p=0.09), 44% and 51% an a-IPI higher than 1 (p=0.47). Median DD delay was 2% versus 14% for R-CHOP21 and R-CHOP14 groups (p Conclusions Overall in our series there were no differences in terms of response or survival between patients treated with R-CHOP21 or R-CHOP14. Significantly higher rates of DD delay were observed in the R-CHOP14 group. However, the impact of DD delays on response and survival was only observed in the R-CHOP21 group but not in patients treated with R-CHOP14. We can conclude that R-CHOP21 and R-CHOP14 are equivalent regimens in terms of response and survival only if DD delays are avoided. For patients receiving R-CHOP21 we recommend using clinical and support measures in order to avoid DD delays. Disclosures: No relevant conflicts of interest to declare.