Biochemical Response Evaluation on Lymphomas: Proposing a Scoring System
Authors: Erdat Efe Cem 
Published: February 2023

Abstract
Biochemical tests are used for prognostic stratification of lymphoma, but there is no reasonable way to use biochemical tests for response assessment. This study involved 108 patients treated with lymphoma at the Department of Medical Oncology, Hacettepe University, between January 2015 and December 2017. Patients were classified into "good responders" and "poor responders". The changes in biochemical parameters were evaluated for their usefulness in assessing the response of patients with good and poor response. Fifty-seven patients were male, 51 patients were female, and the mean age of the patients was 49.0 years. 27 patients had HL, 71 patients had B-cell NHL, 9 patients had T-cell NHL, and one patient had EBV-related lymphoproliferative disease. Levels of total protein (from 7.12 to 6.79 gr/dL, p < 0.01), ß2-microglobulin (from 2287 to 2039 ng/mL, p = 0.07) and lactate dehydrogenase (from 297.8 to 230.1 U/L, p < 0.01) decreased in patients with good response. After transformation of parameters, a 4-point ordinal system consisting of total protein, ß2-microglobulin and lactate dehydrogenase values was proposed. Further analysis showed a nearly high effect size (Cramer's V 0.461). Our study is the first to propose a scoring system for response assessment in lymphoma. Structured abstract Background: Lymphomas are different groups of lymphoid malignancies, but their classification and evaluation of response is done in a similar manner. Biochemical tests are used for prognostic stratification of lymphomas, but there is no reasonable way to use biochemical tests to assess response. Patients and Methods: We enrolled 108 patients treated with lymphoma in the Department of Medical Oncology, Hacettepe University, between January 2015 and December 2017. Patients were divided into good and poor responders. The changes in biochemical parameters were evaluated for their usefulness in assessing the response of patients with good and poor response. The proposed scoring system was evaluated for its effect size using Cramer's V test. Results: Fifty-seven patients were male, 51 patients were female, and the mean age of the patients was 49.0 years. 27 patients had HL, 71 patients had B-cell NHL, 9 patients had T-cell NHL, and one patient had EBV-related lymphoproliferative disease. 53 patients had stage IV, nine patients had stage III, 23 patients had stage II, and 22 patients had stage I disease. Levels of total protein (from 7.12 to 6.79 gr/dL, p < 0.01), ß2-microglobulin (from 2287 to 2039 ng/mL, p = 0.07), and lactate dehydrogenase (from 297.8 to 230.1 U/L, p < 0.01) decreased in patients with good response, whereas nothing significant was found in patients with poor response. After transformation of parameters, a 4-point ordinal system consisting of total protein, ß2-microglobulin, and lactate dehydrogenase values was proposed. Further analysis showed a nearly high effect size (Cramer's V 0.461) and significance in logistic regression (p < 0.01). Conclusion: Our study is the first to propose a scoring system for response assessment in lymphoma. Further studies are needed to confirm our scoring system.