Integrated Prognostic Modelling with the CALLY Index and Interim PET/CT in Hodgkin Lymphoma.
- 1Department of Hematology, Başakşehir Çam and Sakura City Hospital, 34480 Istanbul, Turkey.
Abstract
Background/Objectives: Interim ¹⁸F-FDG PET/CT is the most powerful prognostic tool in Hodgkin lymphoma but is only available after 2 cycles and does not guide initial treatment. The C-reactive protein-albumin-lymphocyte (CALLY) index is a novel composite index of inflammation, nutrition, and immunity, measurable at diagnosis, but has not been studied in Hodgkin lymphoma (HL). We tested whether baseline CALLY could predict interim PET response and survival and whether combining the two provides additional information over either alone. Methods: A retrospective study of 180 consecutive patients with newly diagnosed Hodgkin lymphoma at a single center was performed. CALLY was defined as albumin (g/L) × lymphocytes (×109/L)/CRP (mg/L). Interim PET after two cycles was scored using the Deauville scale (4-5 positive). The endpoints were progression-free survival (PFS) and overall survival (OS). Results: Median follow-up was 30.5 months, 32 patients had a PFS event, and 16 died. Interim PET was positive in 31/163 patients (19.0%). Baseline CALLY was lower in PET-positive patients compared with PET-negative patients (median 1.16 vs. 3.34; p = 0.022; area under the curve 0.635, modest discrimination). Interim PET positivity (29.8% vs. 13.0%; OR 2.84, 95% CI 1.26-6.42), 24-month PFS (66.9% vs. 89.8%; p = 0.001) and OS (84.8% vs. 95.5%; p = 0.022) were reduced below a Youden-derived threshold of 1.5. CALLY was not independently prognostic after adjustment for interim PET (PFS hazard ratio [HR] 1.86, 95% CI 0.79-4.37; p = 0.157). A three-tier exploratory model combining both factors separated 24-month PFS into 94.5% (n = 87), 79.6% (n = 53), and 41.2% (n = 17) (p < 0.001; high- vs. low-risk HR 9.48, 95% CI 3.59-25.04), although the intermediate tier was not statistically different from the low-risk tier. Conclusions: In this cohort, baseline CALLY provides a low-cost pre-treatment correlate of early metabolic response and outcome, with numerically greater discrimination than the International Prognostic Score. Its prognostic signal seems largely mediated through the interim PET response, and therefore it should complement, not replace, interim response assessment. Discrimination was modest, and the integrated model is exploratory and requires prospective multicenter validation in contemporary protocols before clinical use.
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BibTeX
@article{goze2026integrated,
title = {{Integrated Prognostic Modelling with the CALLY Index and Interim PET/CT in Hodgkin Lymphoma.}},
author = {Hasan Göze and İsmail Eren Polat and Nermin Bal and İsa Yalçınkaya and Gokhan Burul and Büşra Tuğçe Tonyalı and Tahir Alper Cinli and İstemi Serin},
journal = {Cancers},
year = {2026},
month = oct,
doi = {10.3390/cancers18193205},
url = {https://europepmc.org/article/MED/42882899},
note = {CC BY},
}
RIS
TY - JOUR
TI - Integrated Prognostic Modelling with the CALLY Index and Interim PET/CT in Hodgkin Lymphoma.
AU - Hasan Göze
AU - İsmail Eren Polat
AU - Nermin Bal
AU - İsa Yalçınkaya
AU - Gokhan Burul
AU - Büşra Tuğçe Tonyalı
AU - Tahir Alper Cinli
AU - İstemi Serin
PY - 2026
DA - 2026/10/04
JO - Cancers
DO - 10.3390/cancers18193205
UR - https://europepmc.org/article/MED/42882899
AB - Background/Objectives: Interim ¹⁸F-FDG PET/CT is the most powerful prognostic tool in Hodgkin lymphoma but is only available after 2 cycles and does not guide initial treatment. The C-reactive protein-albumin-lymphocyte (CALLY) index is a novel composite index of inflammation, nutrition, and immunity, measurable at diagnosis, but has not been studied in Hodgkin lymphoma (HL). We tested whether baseline CALLY could predict interim PET response and survival and whether combining the two provides additional information over either alone. Methods: A retrospective study of 180 consecutive patients with newly diagnosed Hodgkin lymphoma at a single center was performed. CALLY was defined as albumin (g/L) × lymphocytes (×109/L)/CRP (mg/L). Interim PET after two cycles was scored using the Deauville scale (4-5 positive). The endpoints were progression-free survival (PFS) and overall survival (OS). Results: Median follow-up was 30.5 months, 32 patients had a PFS event, and 16 died. Interim PET was positive in 31/163 patients (19.0%). Baseline CALLY was lower in PET-positive patients compared with PET-negative patients (median 1.16 vs. 3.34; p = 0.022; area under the curve 0.635, modest discrimination). Interim PET positivity (29.8% vs. 13.0%; OR 2.84, 95% CI 1.26-6.42), 24-month PFS (66.9% vs. 89.8%; p = 0.001) and OS (84.8% vs. 95.5%; p = 0.022) were reduced below a Youden-derived threshold of 1.5. CALLY was not independently prognostic after adjustment for interim PET (PFS hazard ratio [HR] 1.86, 95% CI 0.79-4.37; p = 0.157). A three-tier exploratory model combining both factors separated 24-month PFS into 94.5% (n = 87), 79.6% (n = 53), and 41.2% (n = 17) (p < 0.001; high- vs. low-risk HR 9.48, 95% CI 3.59-25.04), although the intermediate tier was not statistically different from the low-risk tier. Conclusions: In this cohort, baseline CALLY provides a low-cost pre-treatment correlate of early metabolic response and outcome, with numerically greater discrimination than the International Prognostic Score. Its prognostic signal seems largely mediated through the interim PET response, and therefore it should complement, not replace, interim response assessment. Discrimination was modest, and the integrated model is exploratory and requires prospective multicenter validation in contemporary protocols before clinical use.
SN - 2072-6694
ER -