Early Chemotherapy Response in Patients with Non-Hodgkin Lymphoma Using Baseline Neutrophil–Lymphocyte Ratio as a Predictor in a Nigerian Tertiary Centre
Chiemelie Raluchukwu Onwasigwe, Michael Chidiebele Egolum, Angela Ogechukwu Ugwu, Hector Okechukwu Obianyido
International Blood Research & Reviews · pp. 70–77 · Published 26 Jun 2026
10.9734/ibrr/2026/v17i3389Abstract
Background: Non-Hodgkin lymphoma is a heterogeneous group of lymphoid malignancies with variable clinical behaviour and treatment outcomes. In resource-constrained settings, limited access to advanced prognostic investigations increases the need for simple biomarkers. This study evaluated the association between baseline neutrophil-to-lymphocyte ratio and early chemotherapy response in a Nigerian tertiary centre. Methods: This prospective observational study included 50 consecutive patients with histologically confirmed non-Hodgkin lymphoma at the University of Nigeria Teaching Hospital. Baseline clinical data and full blood count parameters were obtained before chemotherapy. The neutrophil-to-lymphocyte ratio was calculated from absolute neutrophil and lymphocyte counts, and patients were categorised into low (<4.5) and high (≥4.5) groups. All patients received CHOP-based chemotherapy; rituximab was administered to 10 patients based on CD20 positivity, availability and financial considerations. Early response was assessed after three chemotherapy cycles. Results: The mean age was 47 ± 14 years, and 28 patients (56%) were male. Thirty patients (60%) presented with stage III–IV disease, and 29 (58%) had a high baseline neutrophil-to-lymphocyte ratio. After three cycles, 19 patients (38%) achieved complete response, 18 (36%) had partial response and 13 (26%) had no response. Complete response occurred in 12 of 21 patients (57.1%) with low neutrophil-to-lymphocyte ratio and 7 of 29 patients (24.1%) with high neutrophil-to-lymphocyte ratio. Elevated neutrophil-to-lymphocyte ratio remained associated with poor early response after adjustment for age, stage and rituximab use. Conclusion: Baseline neutrophil-to-lymphocyte ratio may be an accessible adjunctive marker of early chemotherapy response in patients with non-Hodgkin lymphoma in resource-limited settings.
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