Peripheral blood biomarkers of early immune reconstitution in newly diagnosed multiple myeloma

Binder, Moritz; Rajkumar, S. Vincent; Lacy, Martha Q.; Gertz, Morie A.; Buadi, Francis K.; Dispenzieri, Angela; Hwa, Yi L.; Fonder, Amie; Hobbs, Miriam; Hayman, Suzanne R.; Zeldenrust, Steven R.; Lust, John A.; Russell, Stephen J.; Leung, Nelson; Kapoor, Prashant; Go, Ronald S.; Gonsalves, Wilson I.; Kourelis, Taxiarchis; Warsame, Rahma; Kyle, Robert A.; Kumar, Shaji

doi:10.1002/ajh.25365

Cited by 19 publications

(21 citation statements)

References 31 publications

(34 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The early immune reconstitution of multiple myeloma is defined as the recovery of absolute lymphocyte count and monocyte counts to normal reference range 1 month after treatment initiation ( 22 ). Therefore, we analyzed the effect of NMLR on early immune reconstitution in MM patients.…”

Section: Resultsmentioning

confidence: 99%

“…Another important finding of this study was that the proportion of patients with high NMLR who achieved early immune reconstitution after 1 month of treatment with BCD was significantly smaller than that of patients with low NMLR, and the NMLR value at diagnosis of patients who achieved early immune reconstitution was significantly lower than those without early immune reconstitution. These results suggested that the treatment based on bortezomib may not overcome the effect of immunosuppressive microenvironment on the poor prognosis of MM, which may be related to the mechanism of bortezomib ( 14 , 22 ). The possible explanation for this finding is the specific mechanism of action of bortezomib.…”

Section: Discussionmentioning

confidence: 96%

“…Peripheral blood absolute lymphocyte count (ALC), absolute neutrophil count (ANC) and absolute monocyte count (AMC) have been used as good surrogate markers of immune surveillance in several solid tumors and hematologic malignancies including MM ( 23 – 26 ). In MM, ANC/ALC ratio (NLR) and ALC/AMC ratio (LMR) have been found to be independent prognostic factors at the time of diagnosis, before, and after autologous hematopoietic stem cell transplantation ( 13 , 17 – 19 , 22 ). Most of them concluded that elevated NLR and low LMR could predict poor prognosis.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

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.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

show abstract

“…Our data supports the notion that hyperdiploidy retains its prognostic significance among patients with SRD. Peripheral blood absolute lymphocyte and monocyte counts have been used as surrogate markers of the tumour microenvironment and immune surveillance in several haematological malignancies, including multiple myeloma (Jimenez‐Zepeda et al , ; Dosani et al , ; Binder et al , ). Our data are consistent with these observations in newly diagnosed disease and abnormal lymphocyte counts remained of prognostic significance among patients with SRD.…”

Section: Discussionmentioning

confidence: 99%

Substratification of patients with newly diagnosed standard‐risk multiple myeloma

et al. 2019

Self Cite

View full text Add to dashboard Cite

Summary Despite the absence of high‐risk cytogenetics and lower International Staging System (ISS) stages, a subset of patients with multiple myeloma (MM) experience poor overall survival (OS). We studied 1461 patients with newly diagnosed MM to identify patient and disease characteristics that predict a high‐risk phenotype among standard‐risk patients. Fifty‐six percent of all patients presented with standard‐risk disease. Among them, advanced age, extremes of body mass index, non‐hyperdiploid karyotype and abnormal lymphocyte counts were associated with worse OS. Standard‐risk patients with 0–1 of these adverse factors (hazard ratio [HR] 0·32, 95% confidence interval [CI] 0·24–0·43, P < 0·001) and 2 adverse factors (HR 0·54, 95% CI 0·41–0·72, P < 0·001) experienced better OS than high‐risk patients. Two or more adverse factors were present in 17% of standard‐risk patients and were associated with OS comparable to high‐risk patients (HR 0·91, 95% CI 0·67–1·24, P = 0·548). Predictive power among standard‐risk patients was improved using score groups compared to ISS stages. Patients with standard‐risk MM are a heterogeneous group with one in six patients experiencing OS comparable to high‐risk disease. Patients at risk can be identified using readily available patient and disease characteristics. These findings emphasize the importance of accurate risk stratification and help explain part of the heterogeneity observed in clinical practice.

show abstract

“…Recently, with the increasing understanding of the connection between the immune system and tumor, immunotherapy is receiving increasing attention and the prognosis value of systemic immunerelated markers has been investigated in various tumors [5][6][7] . Because of the more convenient and affordable for detecting, absolute lymphocyte count (ALC) and monocyte count (AMC) in blood routine examination have been widely used for immune surveillance in several hematologic malignancies and solid tumors [8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of immunity change after treatment for patients with locally advanced gastric cancer: a retrospective study

Wang¹,

Ren²,

Ma³

et al. 2019

Preprint

View full text Add to dashboard Cite

Background Although the preoperative immune status is associated with the prognosis in some tumors, less is known about the prognostic significance of immune status change during the treatment of patients with locally advanced gastric cancer (LAGC).Methods The records of 210 patients with LAGC were retrospectively analysed. The pre-, and post-treatment (after gastrectomy and three cycles of chemotherapy) values of lymphocyte-to-monocyte ratio (LMR) and change of LMR (cLMR) were evaluated. A novel immunity change score (ICS) incorporated both preoperative LMR (pLMR) and cLMR was developed and its prognostic value was evaluated.Results cLMR was an independent predictor and patients with cLMR >1 after treatment had a favorable survival compared with the others (51 vs 31 months, P < 0.001). Based on the cLMR and pLMR, the ICS was defined as follows: ICS=1 (pLMR≤4.53 and cLMR≤1); ICS=2 (pLMR≤4.53 and cLMR>1, or pLMR>4.53 and cLMR≤1); and ICS=3 (pLMR>4.53 and cLMR>1). Multivariate analysis revealed that the ICS was a significant independent biomarker ( P < 0.001). The performances of ICS in terms of the time-dependent receiver operating characteristics (t-ROC) curve and concordance index (C-index) analysis were better than those of pLMR and cLMR. Then we established a nomogram incorporated the ICS, CEA, and TNM stage to predict the 3- and 5- year survival. Decision curve analysis and calibration curve demonstrated that the nomogram was clinically useful.Conclusion The dynamic change of immune status is significantly associated with prognosis for LAGC patients. Combining with the cLMR and pLMR could improve the prognostication for LAGC patients.

show abstract

Peripheral blood biomarkers of early immune reconstitution in newly diagnosed multiple myeloma

Cited by 19 publications

References 31 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

Substratification of patients with newly diagnosed standard‐risk multiple myeloma

Prognostic value of immunity change after treatment for patients with locally advanced gastric cancer: a retrospective study

Contact Info

Product

Resources

About