Ratio of peripheral blood absolute lymphocyte count to absolute monocyte count at diagnosis is associated with progression-free survival in follicular lymphoma

Abstract

The prognosis of follicular lymphoma (FL) is significantly associated with host immunity and tumor microenvironment. Lymphopenia has been identified as a negative prognostic factor for FL. The association between monocytosis and progression-free survival (PFS) in FL remains controversial. It is unknown whether the ratio of peripheral blood absolute lymphocyte count to absolute monocyte count (ALC/AMC) at diagnosis is associated with FL prognosis. We studied 99 consecutive patients with FL who were treated with rituximab-containing chemotherapy at Kitano Hospital or Kyoto University Hospital between 2000 and 2012. We analyzed individual variables associated with the ALC/AMC ratio before treatment, as well as known prognostic factors of FL, and found that an ALC/AMC ratio of 4.7 was the best cut-off value for PFS. Kaplan-Meier analysis showed that a decreased ALC/AMC ratio was associated with inferior PFS (P = 0.022). Multivariate analysis showed that a decreased ALC/AMC ratio was a significant poor prognostic factor independent of other variables (hazard ratio, 2.714; 95 % confidence interval, 1.060-6.948; P = 0.037). The ALC/AMC ratio before treatment may be a significant prognostic factor predicting PFS of FL.

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

“…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.…”

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

“…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).…”

“…Current available prognostic scores retained predictive value in rituximab era, which was confirmed in our study where the NCCN-IPI strongly influenced survival, while the IELSG and the FLIPI retained prognostic value for OS. The potential prognostic role of ALC, AMC and ALC/ AMC, alone or in combination, as the biomarkers of immune microenvironment and host immunity was highlighted by the studies based on GEP and immunohistochemistry [4][5][6][7][8][9][10][11]. Our study didn't confirm the prognostic significance of ALC and AMC alone in DLBCL, while ALC/AMC in Cox regression model was highly prognostic (HR 3.80, 95 % CI 1.80-8.06).…”

“…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].…”

“…However, the lack of availability of GEP in a routine clinical practice and unsatisfactory correlation with immunohistochemical algorithms, has pointed out the need of recognition of additional markers [2]. Furthermore, GEP and immunohistochemistry based studies in NHL have emphasized the role of tumour microenvironment (tumour associated macrophages) and host immune homeostasis (tumour infiltrating lymphocytes) in lymphoma development which has resulted in recognition of the prognostic importance of absolute lymphocyte count (ALC) at diagnosis, absolute monocyte count (AMC) and possibly lymphocyte-tomonocyte ratio (ALC/AMC) [4][5][6][7][8][9][10][11]. According to the GEP analysis, majority of primary CNS DLBCL belong to the unfavourable non-GCB subtype, however the role of microenvironment in CNS is still unclear [12][13][14].…”