Absolute lymphocyte count as a prognostic marker in newly diagnosed multiple myeloma patients

Suriu, Celia; Akria, Luiza; Azoulay, David; Shaoul, Ety; Barhoum, Masad; Braester, Andrei

doi:10.1111/ijlh.12482

Cited by 7 publications

(9 citation statements)

References 12 publications

(14 reference statements)

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“…Firstly, the peripheral blood ANC and AMC are precursor cell for myeloid-derived suppressor cells (MDSC) and tumor-associated macrophages (TAM), respectively, which release growth and survival factors promoting tumor evasion of the host defense mechanisms ( 14 , 17 ). On the contrary, infiltrating lymphocytes were associated with favorable prognosis, as was recently shown in patients with MM ( 16 , 27 ). Therefore, NMLR will be a good surrogate marker of the real in vivo balance of immune system.…”

Section: Discussionsupporting

confidence: 54%

“…How to evaluate the overall immune status of patients is an urgent problem in clinical practice. Recent researches reported that neutrophils inhibit the activation of T cells by reactive oxygen species, and monocytes as precursors of tumor-associated macrophages are closely related to the formation of MM immunosuppressive microenvironment, and absolute lymphocyte counts are independent prognostic factors for survival ( 14 – 16 ). Although there are some controversies, some evidence demonstrated that absolute neutrophils count (ANC) to the absolute lymphocyte count (ALC) ratio (NLR) and ALC to the absolute monocyte count (AMC) ratio (LMR), as immune state indicators of MM patients, play important roles in disease progression ( 14 , 17 , 18 ), which indicated that both neutrophils and monocytes are indispensable components in the complex immune microenvironment of MM and play different roles ( 19 ).…”

Section: Introductionmentioning

confidence: 99%

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The (Neutrophils + Monocyte)/Lymphocyte Ratio Is an Independent Prognostic Factor for Progression-Free Survival in Newly Diagnosed Multiple Myeloma Patients Treated With BCD Regimen

et al. 2020

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Objective Bortezomib is one of the important drugs that have made breakthrough progress in multiple myeloma (MM) in the past 10 years. However, the heterogeneity of its efficacy makes it difficult to predict the risk of disease progression. The purpose of this study is to determine the prognostic significance of the (neutrophils + monocytes)/lymphocytes ratio (NMLR) in newly diagnosed MM patients who received BCD regimen therapy in terms of progression-free survival (PFS). Methods A total of 150 patients who fulfilled the International Myeloma Working Group (IMWG) criteria were enrolled in the study retrospectively. The prognostic value of NMLR was evaluated by 150 patients with MM who were treated with BCD (bortezomib + cyclophosphamide + dexamethasone) regimen therapy. NMLR was calculated by the ratio of (neutrophils + monocyte) to lymphocytes. According to receiver operating characteristic curves, the cutoff value was 1.90. The patients were divided into high NMLR group (H-NMLR, NMLR ≥1.90) and low NMLR group (L-NMLR, NMLR <1.90). The clinical characteristics, treatment responses and PFS of the two groups were analyzed. Results The median age of the patients was 61 years. Fifty-five (36.67%) patients showed lower NMLR at initial diagnosis. Although NMLR was unable to discriminate prognosis in ISS stage I/II patients, interestingly, the addition of NMLR to the ISS further defined prognosis particularly in stage III. Low-NMLR group who achieved early immune reconstruction significantly higher than that of the high-NMLR group ( P < 0.001). NMLR value was 1.98 ± 1.02 for the patients who achieved early immune reconstruction, which was 3.26 ± 2.52 for the patients without immune reconstruction ( P < 0.05). Compared with the H-NMLR group, the levels of β2-microglobulin, serum creatinine and calcium were lower, and the very good partial response or better (≥VGPR) ratio was higher in L-NMLR group. The L-NMLR group experienced a superior median PFS compared with the H-NMLR group (24.0 versus 15.5 months; P < 0.001). In addition, several other prognostic factors of PFS were estimated, including the high-risk cytogenetics, β2-microglobulin and the depth of treatment response 3 months after treatment with BCD regimen. Moreover, NMLR was an independent predictor of PFS including non-high risk cytogenetics (0.587; P = 0.031). Conclusion In patients with newly diagnosed MM undergoing BCD regimen, the NMLR <1.90 was an independent prognostic factor for PFS as well as early immune reconstruction and lower disease burden.

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Section: Discussionsupporting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

The (Neutrophils + Monocyte)/Lymphocyte Ratio Is an Independent Prognostic Factor for Progression-Free Survival in Newly Diagnosed Multiple Myeloma Patients Treated With BCD Regimen

et al. 2020

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“…Treatment with lenalidomide provides an alternative choice for elderly patients and those unable to tolerate chemotherapy ( 16 , 17 ). In addition, prognostic factors, including peripheral lymphocytes and CRP, have been reported and were demonstrated to have a varying prognostic significance in traditional chemotherapy and novel drug protocols ( 4 , 5 , 18 , 19 ). This highlights the importance of discovering and identifying prognostic markers in MM for novel treatment approaches.…”

Section: Discussionmentioning

confidence: 99%

Association of CD117 and HLA‑DR expression with shorter overall survival and/or progression‑free survival in patients with multiple myeloma treated with bortezomib and thalidomide combination treatment without transplantation

et al. 2018

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Certain immunophenotypes in multiple myeloma (MM), including CD56 and CD117, have been reported to be associated with overall survival (OS). However, previous reports have ignored the impact of different treatment regimens and the long-term prognostic value of immunophenotyping in MM when treated with novel agents, including thalidomide and bortezomib, in the absence of transplantation for autologous stem cell transplantation and allo-hematopoietic stem cell transplantation. To further understand the long-term prognostic value of immunophenotyping in MM, when treated with bortezomib combined with thalidomide-based regimens without transplantation, 80 patients who were newly diagnosed between January 2007 and December 2015, were analyzed retrospectively. In contrast to previous studies, no significant survival time difference was observed between CD56+/CD117+ and CD56-/CD117- groups. Multivariate analysis suggested that human leukocyte antigen-antigen D-related (HLA-DR)+ was independently associated with shorter OS and progression-free survival (PFS), while CD117+ was an independent prognostic factor for decreased PFS. In addition, the myeloma prognostic index (MPI), defined by HLA-DR+, age ≥65 years and international staging system stage III, was suitable for risk stratification of patients treated with novel agents for OS and PFS. The results of the current study suggested that HLA-DR+ patients had a shorter OS and PFS and CD117+ patients had shorter PFS. HLA-DR+ or CD117+ was sufficient to affect survival. Evaluating these markers may reveal valuable prognostic factors for MM in patients receiving bortezomib combined with thalidomide-based regimens without autologous stem cell transplantation and allo-hematopoietic stem cell transplantation). MPI may describe an accessible tool to predict the prognosis of patients with MM.

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“…Interestingly, although previous studies had suggested ALC as a prognostic marker, recent investigations with the novel agents failed to demonstrate statistical significance. 12, 13 Our study is novel in that we show that the ALC/AMC is a more robust prognostic biomarker than ALC alone, as it assesses the relative strength of the host immune system to myeloma-induced immune dysfunction. To our knowledge, these findings have only once been suggested in a smaller Korean cohort 14 —our study in a larger cohort confirms and expands these findings in an immune context.…”

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confidence: 87%

Significance of the absolute lymphocyte/monocyte ratio as a prognostic immune biomarker in newly diagnosed multiple myeloma

et al. 2017

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Absolute lymphocyte count as a prognostic marker in newly diagnosed multiple myeloma patients

Abstract: Absolute lymphocyte count as a prognostic marker in newly diagnosed multiple myeloma patients e56

Cited by 7 publications

References 12 publications

The (Neutrophils + Monocyte)/Lymphocyte Ratio Is an Independent Prognostic Factor for Progression-Free Survival in Newly Diagnosed Multiple Myeloma Patients Treated With BCD Regimen

The (Neutrophils + Monocyte)/Lymphocyte Ratio Is an Independent Prognostic Factor for Progression-Free Survival in Newly Diagnosed Multiple Myeloma Patients Treated With BCD Regimen

Association of CD117 and HLA‑DR expression with shorter overall survival and/or progression‑free survival in patients with multiple myeloma treated with bortezomib and thalidomide combination treatment without transplantation

Significance of the absolute lymphocyte/monocyte ratio as a prognostic immune biomarker in newly diagnosed multiple myeloma

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