BLNK as an Important Prognostic Indicator for Survival in Pediatric Classic Hodgkin Lymphoma: A Single-Center Retrospective Study

Background Classic Hodgkin lymphoma (cHL) was one of malignant tumors in children. At present, there are still patients who cannot be cured with first-line treatment. And many cured patients continue to die prematurely due to the late toxic effects of treatment. In addition, there is currently a lack of effective early survival prediction biomarkers. This study aimed to explore the predictive value of B-Cell Linker Protein (BLNK) in cHL. Methods 63 patients from the Fourth Hospital of Hebei Medical University were included in the study from January 2008 to March 2024. Immunohistochemistry was employed to measure the expression of BLNK. 11 patients with BLNK positive cell number 1 ~ 10% (BLNK negative, BLNK-), and 52 patients with BLNK positive cell number 10 ~ 50% (BLNK positive, BLNK+). And correlation between BLNK expression and clinicopathological features was analyzed. Univariate and multivariate cox analysis was used to determine the independent prognostic variables of overall survival (OS) and progression free survival (PFS). Then Construction and validation of nomogram to predict EOS probability. Results The OS and PFS of cHL patients in BLNK- group was significantly better than those patients in BLNK + group. BLNK expression, the presence of bulky disease, B lymphocyte count, LDH levels and neutrophil count were determined as independent prognostic factors by multivariable Cox regression analysis of PFS. And the nomogram model was constructed based on these factors. The nomogram provides a good distinguishing ability, and C-indices for 12, 24, 36, and 60 months were 0.809、0.867、0.906、0.903, respectively. The result of calibration curve suggested that there is a strong agreement between the forecast and actual observations. The subgroup analysis successfully identified a sensitive population for prognosis in cHL by BLNK level. And then in subgroups with large tumor masses, stages III–IV, chemotherapy regimens (1/2), CRP > 7.5 mg/L, B lymphocyte count > 5.7 × 10^6/L, LDH ≤ 261.25, lymphocyte count ≤ 3.68 × 10^9/L, and platelet count ≤ 387 × 10^9/L, the PFS in the BLNK negative group has a greater impact on PFS. Conclusion BLNK was downregulated in cHL, which was the prognostic variable on PFS of cHL. This study developed a BLNK-based prognostic model capable of predicting PFS outcomes in cHL patients, and screened the sensitive population of BLNK for PFS survival prediction.