Abstract
BACKGROUND: Extranodal natural killer/T-cell lymphoma (ENKTL) is an aggressive disease with grim prognosis. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score has been identified as a predictive marker for prognosis in various malignancies. However, the prognostic significance of the HALP score in the context of ENKTL has yet to be established. AIMS: Our objective was to assess the predictive power of the initial HALP score for ENKTL patients regarding their prognosis. METHODS: We conducted a retrospective analysis of 296 early-stage, low-risk ENKTL patients who were newly diagnosed and treated with asparaginase-based therapies. We evaluated the significance of HALP score as a predictor of response to treatment, overall survival (OS), and progression-free survival (PFS). RESULTS: The median follow‑up for all patients was 72 months. We identified that a low HALP score was associated with a poorer Eastern Cooperative Oncology Group (ECOG) performance status (PS), the presence of B symptoms, male gender, and increased lactate dehydrogenase (LDH) levels (all p < 0.05), as well as a suboptimal response to therapy (p = 0.006). In the prognostic index of natural killer cell lymphoma (PINK) model, low-risk ENKTL patients with a HALP score below 32.6 exhibited significantly worse 5-year OS at 51.8% compared to 75.5% for those with a HALP score of 32.6 or above (p < 0.001), and 5-year PFS at 47.1% compared to 69.9% (p < 0.001). Integrating Epstein-Barr virus (EBV)-DNA titer into the PINK model led to the development of an additional prognostic index, the PINK-E model. According to this model, low-risk ENKTL patients with a HALP score below 32.6 had significantly poorer 5-year OS at 46.0% compared to 73.1% for those with a HALP score of 32.6 or above (p < 0.001), and 5-year PFS at 40.8% compared to 68.5% (p < 0.001). CONCLUSION: Low HALP score was associated with unfavorable clinicopathological characteristics of ENKTL patients with low-risk and early-stage disease, suggesting that it may serve as an independent, negative prognostic indicator.