BLNK as an important prognostic indicator for survival in pediatric classic hodgkin lymphoma patients: a single-center retrospective study.
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Classic Hodgkin lymphoma (cHL) is a malignant tumor in children. At present, some patients cannot be cured with first-line treatment, and many cured patients die prematurely because of the late toxic effects of treatment. In addition, effective early survival prediction biomarkers are lacking. The aim of this study was to explore the predictive value of B-cell linker protein (BLNK) in cHL. Sixty-three patients from the Fourth Hospital of Hebei Medical University were included in the study from January 2008 to March 2024 (training set). Immunohistochemistry was used to measure the expression of BLNK. Eleven patients with < 10% BLNK-positive cells (BLNK-negative, BLNK-) and 52 patients with 10 ~ 49% BLNK-positive cells (BLNK-positive, BLNK+) were included. The correlations between BLNK expression and clinicopathological features were analyzed. Univariate and multivariate Cox analyses were used to determine the independent prognostic variables of overall survival (OS) and progression-free survival (PFS). Construction and validation of nomogram to predict PFS of cHL patients. In addition, we included 29 patients with cHL who were admitted between January 2000 and December 2007 as a validation set to explore the robustness of the above prediction model. The OS and PFS of cHL patients in the BLNK+ group were significantly longer than those of patients in the BLNK- group. BLNK expression, the presence of bulky disease, the B lymphocyte count, LDH levels and the neutrophil count were determined to be independent prognostic factors by multivariable Cox regression analysis of PFS. A nomogram model was constructed based on these factors. The discriminative ability of the nomogram was good; the C-index was 0.844 (0.761, 0.926) in the training set and 0.824 (0.717, 0.931) in the validation set. The results of the calibration curve suggested strong agreement between the forecast and actual observations in both the training set and the validation set. Subgroup analysis successfully identified a treatment-sensitive population of cHL patients to predict prognosis according to the BLNK level. In the subgroups without giant tumor lesions, an age≥9 years, St. Jude Stages III-IV, chemotherapy regimens (1/2), a CRP concentration >7.5 mg/L, a B lymphocyte count >5.7 × 10^6/L, a lymphocyte count ≤ 3.68 × 10^9/L, and a platelet count ≤ 387 × 10^9/L had a greater effect on PFS in the BLNK-negative group. An age ≥9 years, St. Jude Stages III-IV, the absence of a giant tumor lesion, a chemotherapy regimen (2), a CRP concentration >10.2 mg/L, a B lymphocyte count >18.5 × 10^6/L, an IgG concentration >6.91 g/L, a neutrophil count ≤ 5.6 × 10^9/L, a lymphocyte count >0.49 × 10^9/L, a platelet count >298.5 × 10^9/L, a PLR >199.31, and an NLR >3.17 had a greater effect on OS in the BLNK-negative group. Decreased BLNK expression predicts prolonged PFS among patients with cHL. The validated nomogram integrating BLNK and clinical parameters provides potential predictive value for PFS of cHL. No Clinical trial registration.