Lymphocyte:Monocyte Ratio At The Start Of Conditioning Regimen Is Associated With Survival Post-Autologous Stem Cell Transplantation (ASCT) For Lymphoma and Myeloma

Abstract

Introduction Several studies have suggested that an increased peripheral blood absolute lymphocyte count (ALC) at day 15 after ASCT is associated with improved survival and decreased relapse rate. Recently, the ratio of ALC to the absolute monocyte count (AMC) (Lymphocyte:Monocyte Ratio; LMR) has been described as a strong prognostic factor at time of diagnosis in patients with various lymphoid malignancies. In most reports, a LMR cut-off value of less than 1.1 indicates patients who have a worse outcome. Objective To evaluate the prognostic impact of the LMR at start of conditioning regimen and at day 15 post ASCT in patients with a diagnosis of lymphoma and myeloma Methods We retrospectively reviewed the medical records of 121 adult patients with a diagnosis of lymphoma or myeloma who underwent ASCT at Hospital Israelita Albert Einstein from January, 2005 to July, 2012. Lymphocyte count was registered at the 15th day after SCT and lymphopenia was defined as an ALC< 500 at this time point. The LMR was calculated considering the ALC and AMC at baseline (start of conditioning regimen) and at day 15 post-ASCT. Overall survival (OS) was estimated from the time of transplant until death, with surviving patients censored at last follow-up. Variables entered into the multivariate Cox analysis were those with a p-value <0.10 in the univariate analysis. Statistical analysis was performed with STATA (v11.0) and alfa error was defined as 5%. Results The majority of patients were male (69%) and the median age was 58 years old (range: 3–76). Peripheral stem cell harvest was the main source of cells (61%). Diagnosis included multiple myeloma (49%), non-Hodgkin’s lymphoma (45%) and Hodgkin’s lymphoma (6%). The median LMR at start of conditioning regimen was 0.60, while at day 15 it was 1.75. Seventy-three percent of patients at start of conditioning had a LMR <1.1, while the same percentage at day 15 was 25%. Considering LMR cut-off at 1.1, an increased LMR value at baseline was associated with improved survival (HR 0.44; p=0.03), while it was not predictive at day 15 (HR=0.99; p=0.99). At 2 years, the OS was 48% for patients with a LMR<1.1 at start of conditioning regimen versus 76% for those patients with a LMR ≥1.1 (p=0.03 by logrank). In a multivariate Cox analysis considering age, sex, diagnosis, day 15 lymphopenia and baseline LMR, baseline LMR remained an independent variable associated with survival (HR=0.40, p=0.044), while day15 lymphopenia had no prognostic value (HR=0.80. p=0.56). Conclusion In our cohort of patients, the presence of an increased LMR at baseline before start of conditioning regimen identified a subgroup of patients who had a very good outcome. These results should be validated in other cohorts. Strategies to improve outcome for patients who present with decreased LMR and a better understanding of the role of LMR should be the focus of future studies. Disclosures: No relevant conflicts of interest to declare.

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

“…The relationship between the number of circulating monocytes and clinical outcomes was mainly attributed to their role as precursors of TAM. A prognostic significance was also reported for the LMR (lymphocyte/monocyte ratio) in newly diagnosed myeloma patients [8] and also at the start of the conditioning regimen of autologous stem cell transplantation (ASCT) [9].…”