Peripheral Blood Lymphocyte/Monocyte Ratio Predicts Outcome in Follicular Lymphoma and in Diffuse Large B-Cell Lymphoma Patients in the Rituximab Era

Belotti, Angelo; Doni, Elisa; Bolis, Silvia; Rossini, Fausto; Casaroli, Ivana; Pezzatti, Sara; Pogliani, Enrico Maria; Pioltelli, Pietro

doi:10.1016/j.clml.2014.10.001

Cited by 39 publications

(31 citation statements)

References 37 publications

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“…Similar data have been also produced for diffuse large B-cell lymphomas (DLBCL) [20][21][22][23][24][25][26][27][28] and follicular lymphomas [28,29], associating lower ALC/AMC with inferior outcomes.…”

Section: Discussionsupporting

confidence: 55%

Prognostic Implication of the Absolute Lymphocyte to Absolute Monocyte Count Ratio in Patients With Classical Hodgkin Lymphoma Treated With Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine or Equivalent Regimens

et al. 2016

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Low absolute lymphocyte count (ALC) to absolute monocyte count (AMC) ratio (ALC/AMC) is an independent prognostic factor in Hodgkin lymphoma (HL), but different cutoffs (1.1, 1.5, and 2.9) have been applied. We aimed to validate the prognostic significance of ALC/AMC in 537 homogenously treated (doxorubicin, bleomycin, vinblastine, and dacarbazine or equivalents ± radiotherapy) classical HL patients at various cutoffs. The median ALC/AMC was 2.24 (0.44–20.50). The median AMC was 0.653 × 109/L (0.050–2.070). Lower ALC/AMC was associated with established markers of adverse prognosis. In total, 477 (89%), 418 (78%), and 189 (35%) patients had an ALC/AMC ratio of ≥1.1, ≥1.5, and ≥2.9; respectively; 20% had monocytosis (≥0.9 × 109/L). Ten-year time to progression (TTP) was 77% versus 55% for patients with ALC/AMC ≥1.1 and <1.1 (p = .0002), 76% versus 68% for ALC/AMC ≥1.5 and <1.5 (p = .049), 77% versus 73% for ALC/AMC ≥2.9 and <2.9 (p = .35), and 79% versus 70% for ALC/AMC ≥2.24 and <2.24 (p = .08), respectively. In stages ΙΑ/ΙΙΑ and in patients ≥60 years old, ALC/AMC had no significant effect on TTP. In advanced stages, ALC/AMC was significant only at the cutoff of 1.1 (10-year TTP 67% vs. 48%; p = .016). In younger, advanced-stage patients, the differences were more pronounced. In multivariate analysis of TTP, ALC/AMC < 1.1 (p = .007) and stage IV (p < .001) were independent prognostic factors; ALC/AMC was independent of International Prognostic Score in another model. ALC/AMC was more predictive of overall survival than TTP. At the cutoff of 1.1, ALC/AMC had independent prognostic value in multivariate analysis. However, the prognostically inferior group comprised only 11% of patients. Further research is needed prior to the widespread use of this promising marker.

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Section: Discussionsupporting

confidence: 55%

Prognostic Implication of the Absolute Lymphocyte to Absolute Monocyte Count Ratio in Patients With Classical Hodgkin Lymphoma Treated With Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine or Equivalent Regimens

et al. 2016

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“…However, we haven't found the prognostic role of AMC, which is supported by the study of Watanabe et al despite that monocytosis was previously marked as possible negative predictive factor for outcome [10,39,40]. The role of ALC/AMC has to be more investigated, since some performed studies have reported different cut off points of ALC/AMC that were used to set the best value which influenced survival [11,33]. We have used the cutoff point for ALC/AMC that was reported by Kumagai et al in the study based on retrospective analysis of 99 patients with FL, and have found the significant influence of AMC/ALC on both EFS and OS, that were also highly prognostic when analysed in Cox regression model [11].…”

Section: Discussionmentioning

confidence: 77%

“…Just recently, the metaanalysis of Lin et al which includes nine studies covering a total of 4198 subjects, showed that low ALC/AMC ratio at diagnosis do have an adverse effect on outcome for DLBCL patients treated with immunochemotherapy [36]. Regarding FL, the role of complete blood counton survival in FL patients treated with immunochemotherapy is less investigated and remains not well established [10,11,33]. ALC has been reported to correlate with treatment response and PFS, whose prognostic significance was confirmed in our study [37,38].…”

Section: Discussionmentioning

confidence: 96%

“…Receiver Operating Characteristic (ROC) curve was used to set the cut-off value of MVD for DLBCL, while median MVD value was set as cut off point for FL. The cut off points for ALC, AMC and ALC/AMC were used according to previously published data, including 1.1 × 10 9 /L, 0.62 × 10 9 /l and 2.6, respectively for DLBCL and 1.1 × 10 9 /L, 0.32 × 10 9 /l and 4.7, respectively for FL [11,32,33] (Fig. 1).…”

Section: Discussionmentioning

confidence: 99%

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The Role of Lymphocyte to Monocyte Ratio, Microvessel Density and HiGH CD44 Tumor Cell Expression in Non Hodgkin Lymphomas

Jelicic

Balint

Jovanović³

et al. 2016

Pathol. Oncol. Res.

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Prognostic significance of immune microenvironment has been emphasized using the most advanced analysis, with consecutive attempts to reveal prognostic impact of this findings. The aim of this study was to compare and define prognostic significance of clinical parameters, microvessel density (MVD) in tumour tissue and expression of CD44s as adhesive molecule on tumour cells in diffuse large B cell lymphoma-DLBCL, primary central nervous system DLBCL-CNS DLBCL and follicular lymphoma-FL. A total of 202 histopathological samples (115 DLBCL/65 FL/22 CNS DLBCL) were evaluated. Overall response (complete/partial remission) was achieved in 81.3 % DLBCL patients, 81.8 % primary CNS DLBCL and 92.3 % FL. Absolute lymphocyte count-ALC/Absolute monocyte count-AMC >2.6 in DLBCL and ALC/AMC ≥ 4.7 in FL were associated with better event-free survival (EFS) and overall survival (OS) (p < 0.05). In DLBCL, MVD > 42 blood vessels/0.36 mm(2) correlated with primary resistant disease (p < 0.0001), poorer EFS and OS (p = 0.014). High CD44s expression in FL correlated with inferior EFS and OS (p < 0.01). In DLBCL, multivariate Cox regression analysis showed that ALC/AMC was independent parameter that affected OS (HR 3.27, 95 % CI 1.51-7.09, p = 0.003) along with the NCCN-IPI (HR 1.39, 95 % CI 1.08-1.79, p = 0.01). Furthermore, in FL, ALC/AMC mostly influenced OS (HR 5.21, 95 % CI 1.17-23.21, p = 0.03), followed with the FLIPI (HR 3.98, 95 % CI 1.06-14.95, p = 0.041). In DLBCL and FL, ALC/AMC is simple and robust tool that is, with current prognostic scores, able to define long-term survival and identify patients with inferior outcome. The introduction of immunochemotherapy might altered the prognostic significance of microenvionmental biomarkers (MVD and CD44s).

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“…The lower LMR was significantly associated with poor CSS in colorectal carcinoma (HR: 0.55, 95% CI: 0.42–0.71; P < 0.001), soft tissue sarcoma (HR: 0.38, 95% CI: 0.20–0.72; P = 0.003), Hodgkin's lymphoma (HR: 0.09, 95% CI: 0.04–0.21; P < 0.001) and other non-hematological malignancies (HR: 0.79, 95% CI: 0.68–0.91; P = 0.002). Fifteen studies comprising 6,440 patients reported hazard ratios for DFS [8, 9, 11, 14, 18, 20, 23, 24, 28, 30, 34, 38, 43, 45, 47]. The effect of LMR on DFS among cancer subgroups is presented in Figure 4B.…”

Section: Resultsmentioning

confidence: 99%

Prognostic role of lymphocyte to monocyte ratio for patients with cancer: evidence from a systematic review and meta-analysis

et al. 2016

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Inflammation influences cancer development and progression, and a low lymphocyte to monocyte ratio (LMR) has been reported to be a poor prognostic indicator in several malignancies. Here we quantify the prognostic impact of this biomarker and assess its consistency in various cancers. Eligible studies were retrieved from PubMed, Embase and Web of Science databases. Overall survival (OS) was the primary outcome, cancer-specific survival (CSS), disease-free survival (DFS), recurrence-free survival (RFS), and progression-free survival (PFS) were secondary outcomes. Pooled hazard ratios (HRs), odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. Fifty-six studies comprising 20,248 patients were included in the analysis. Overall, decreased LMR was significantly associated with shorter OS in non-hematological malignancy (HR: 0.59, 95% CI: 0.53–0.66; P < 0.001) and hematological malignancy (HR: 0.44, 95% CI: 0.34–0.56; P < 0.001). Similar results were found in CSS, DFS, RFS and PFS. Moreover, low LMR was significantly associated with some clinicopathological characteristics that are indicative of poor prognosis and disease aggressiveness. By these results, we conclude that a decreased LMR implied poor prognosis in patients with cancer and could serve as a readily available and inexpensive biomarker for clinical decision.

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Peripheral Blood Lymphocyte/Monocyte Ratio Predicts Outcome in Follicular Lymphoma and in Diffuse Large B-Cell Lymphoma Patients in the Rituximab Era

Cited by 39 publications

References 37 publications

Prognostic Implication of the Absolute Lymphocyte to Absolute Monocyte Count Ratio in Patients With Classical Hodgkin Lymphoma Treated With Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine or Equivalent Regimens

Prognostic Implication of the Absolute Lymphocyte to Absolute Monocyte Count Ratio in Patients With Classical Hodgkin Lymphoma Treated With Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine or Equivalent Regimens

The Role of Lymphocyte to Monocyte Ratio, Microvessel Density and HiGH CD44 Tumor Cell Expression in Non Hodgkin Lymphomas

Prognostic role of lymphocyte to monocyte ratio for patients with cancer: evidence from a systematic review and meta-analysis

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