The lymphocyte to monocyte ratio improves the IPI‐risk definition of diffuse large B‐cell lymphoma when rituximab is added to chemotherapy

Abstract

The peripheral blood lymphocyte to monocyte ratio (LMR) at diagnosis can be clinically relevant in patients with diffuse large B‐cell lymphoma (DLBCL). We reviewed the outcome of 1,057 DLBCL patients followed from 1984 to 2012 at four centers. LMR was analyzed as a clinical biomarker by receiver‐operating characteristic (ROC) analysis and Harrell's C‐statistics. Patients were characterized by a median age of 61 years, International Prognostic Index (IPI) score of >2 in 39%, and were treated with a rituximab‐containing chemotherapy in 66%. LMR proved strongly predictive for survival in patients treated with rituximab‐based programs, but not in those receiving chemotherapy alone. Additionally, an LMR value of ≤2.6 (as determined by ROC analysis) was associated with a worst performance status, a higher lactate dehydrogenase (LDH) level, an advanced clinical stage, and a higher IPI score (P = 0.000). In patients treated with rituximab‐supplemented chemotherapy programs, an LMR value of <2.6 was found in most of the primary refractory patients (75%) which proved as the best cutoff to predict both response and survival (P = 0.018). Finally, multivariate analysis and Harrell's C‐statistics confirmed the IPI‐independent role of LMR on survival (P = 0.0000). In conclusion, LMR is a potent predictor of clinical response and survival in DLBCL treated with rituximab‐containing chemotherapy. Am. J. Hematol. 88:1062–1067, 2013. © 2013 Wiley Periodicals, Inc.

Prognostic impact of absolute lymphocyte count/absolute monocyte count ratio and prognostic score in patients with nasal-type, extranodal natural killer/T-cell lymphoma

“…However, the evidence in ENKTL was insufficient. 20 Rambaldi et al 22 found that ALC/AMC ratio has a strong prognostic relevance and is a risk factor from the IPI when rituximab is added to chemotherapy in diffuse large B-cell lymphoma. Similar results were shown in other cohorts.…”

“…1 ALC/AMC ratio was determined as recorded formerly. [21][22][23][24] ALC/AMC prognostic score was calculated in accordance with Wilcox's study. 19 In general, the patients were classified into three risk groups: low risk (normal ALC and AMC), intermediate risk (low ALC or high AMC), and high risk (low ALC and high AMC).…”

“…Moreover, the value of the incorporation of ALC and AMC has been explored and several studies revealed that ALC/AMC ratio [21][22][23][24] and ALC/AMC prognostic score (low risk and normal ALC and AMC; intermediate risk, low ALC, or high AMC; high risk, low ALC, and high AMC) 19,25,26 were related to survival in certain types of lymphomas. Although there are definite results in these cancers, the role of ALC/ AMC ratio and ALC/AMC prognostic score 20 in ENKTL is still unclear and requires validation in other patient cohorts.…”

Peripheral blood lymphocyte/monocyte ratio at the time of first relapse predicts outcome for patients with relapsed or primary refractory diffuse large B-cell lymphoma

“…Monocytes, which are considered immunologically relevant and are regarded as a surrogate marker of the tumor microenvironment, were also recently reported to be a prognostic factor in DLBCL [8-11], follicular lymphoma (FL) [12,13], T-cell lymphoma [14], extranodal natural killer/T-cell lymphoma (ENKL) [15] and Hodgkin’s Lymphoma (HL) [16,17]. Absolute lymphocyte count/absolute monocyte count ratio (ALC/AMC ratio) at diagnosis, as a simple biomarker combining an estimate of host immune homeostasis and tumor microenvironment, was recently shown to be an independent prognostic indicator in HL [16,17] and DLBCL [10,11]. However, to our best knowledge, there is no data available on whether the ALC/AMC ratio at the time of first relapse predicts outcome in patients with relapsed/primary refractory DLBCL.…”

The Prognostic Significance of Pretreatment Hematologic Parameters in Patients Undergoing Resection for Colorectal Cancer

“…6,7 Other authors have observed that the preoperative neutrophil-to-lymphocyte ratio (NLR) can be used as a prognostic marker in patients with CRC, [8][9][10] although a standard cutoff value has yet to be determined. 11,12 The lymphocyte-tomonocyte ratio (LMR) has been shown to predict for worse outcomes in patients with diffuse large B-cell lymphoma 13 and nasopharyngeal carcinoma. 14 However, its effects in patients with CRC remain undefined.…”