Are the Derived Indexes of Peripheral Whole Blood Cell Counts (NLR, PLR, LMR/MLR) Clinically Significant Prognostic Biomarkers in Multiple Myeloma? A Systematic Review And Meta-Analysis

Abstract

BackgroundMultiple myeloma (MM) is an incurable malignant plasma cell tumor. Whole blood cell count (WBCC) derived indexes are widely used as a predictive biomarker for various types of solid and hematological malignant tumors. Our study is to evaluate its effectiveness in MM by meta-analysis.MethodsRelevant literatures were retrieved from PubMed, Embase and Web of Science databases according to PRISMA guideline. All relevant parameters were extracted and combined for statistical analysis.ResultsNineteen studies incorporating 3818 MM patients were eventually included in this meta-analysis. 13 studies evaluated that elevated NLR was significantly associated with poor survival outcomes (OS: HR=2.04, P<0.001; PFS: HR=1.96, P=0.003). Elevated NLR was revealed to correlate with ISS stage (ISS III VS I-II, OR=2.23, P=0.003). A total of 7 studies have shown that elevated LMR predicts a better prognosis in MM patients (OS: HR=0.57, P<0.001; PFS: HR=0.49, P<0.05), and two other studies demonstrated that increased MLR was related to poor OS/PFS (OS: HR=1.58, P<0.05; PFS: HR=1.60, P<0.05). However, in the other 6 studies including 1560 patients, the prognostic value of PLR had not been confirmed (OS: HR=0.89, P>0.05; PFS: HR=0.87, P>0.05).ConclusionsThe indexes NLR and LMR/MLR derived from WBCC were validated to be useful biomarkers to predict the prognosis in MM patients, but the evidence of PLR was insufficient.

The combination of serum calcium levels, neutrophil‑to‑lymphocyte ratio and platelet count in the prognosis of multiple myeloma: A retrospective cohort study and review of the literature

“…Recent studies have investigated the application of various inflammatory factors as prognostic indices in patients with (12) suggested that a high NLR was an adverse prognostic factor; however, no consensus was reported on its cut-off value (8)(9)(10)(11)(12). These cut-off values ranged from 2 to 3.1 (9)(10)(11)(12).…”

“…These inflammatory factors include the platelet count (PLT), the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the monocyte-to-lymphocyte ratio (MLR) and C-reactive protein (CRP) levels. Previous studies, such as those of Zhang et al (8), Liu et al (9), Kim et al (10), Szudy-Szczyrek et al (11) and Zuo et al (12) suggested that a high NLR was an adverse prognostic factor. However, no consensus has yet been reached on the cut-off value used for the diagnosis of MM.…”

“…Several studies have examined the expression levels of certain inflammatory factors and have suggested that these factors (8)(9)(10) exerted adverse effects on the survival rate of patients with MM. These inflammatory factors include the platelet count (PLT), the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the monocyte-to-lymphocyte ratio (MLR) and C-reactive protein (CRP) levels.…”

“…Inflammatory factors have a substantial impact on the tumor microenvironment and in tumor progression; therefore, they are related to the prognosis of patients with malignant diseases(25). Inflammation-related indices derived from peripheral blood cells, including NLR, PLR and MLR, are considered prognostic biomarkers(8).The majority of the studies have agreed on the prognostic value of NLR. Zhang et al(8), Liu et al (9), Kim et al (10), Szudy-Szczyrek et al (11) and Zuo et al…”

“…Inflammation-related indices derived from peripheral blood cells, including NLR, PLR and MLR, are considered prognostic biomarkers(8).The majority of the studies have agreed on the prognostic value of NLR. Zhang et al(8), Liu et al (9), Kim et al (10), Szudy-Szczyrek et al (11) and Zuo et al…”