Neutrophil/Lymphocyte Ratio, Lymphocyte/Monocyte Ratio, and Absolute Lymphocyte Count/Absolute Monocyte Count Prognostic Score in Diffuse Large B-Cell Lymphoma

The neutrophil/lymphocyte ratio (NLR), lymphocyte/ monocyte ratio (LMR), and absolute lymphocyte count/absolute monocyte count prognostic score (ALC/AMC PS) have been described as the most useful prognostic tools for patients with diffuse large B-cell lymphoma (DLBCL). We retrospectively analyzed 148 Taiwanese patients with newly diagnosed diffuse large B-cell lymphoma under rituximab (R)-CHOP-like regimens from January 2001 to December 2010 at the Tri-Service General Hospital and investigated the utility of these inexpensive tools in our patients. In a univariate analysis, the NLR, LMR, and ALC/AMC PS had significant prognostic value in our DLBCL patients (NLR: 5-year progression-free survival [PFS], P1⁄4 0.001; 5-year overall survival [OS], P1⁄4 0.007. LMR: PFS, P1⁄4 0.003; OS, P1⁄4 0.05. ALC/AMC PS: PFS, P< 0.001; OS, P< 0.001). In a separate multivariate analysis, the ALC/AMC PS appeared to interact less with the other clinical factors but retained statistical significance in the survival analysis (PFS, P1⁄4 0.023; OS, P1⁄4 0.017). The akaike information criterion (AIC) analysis produced scores of 388.773 in the NLR, 387.625 in the LMR, and 372.574 in the ALC/AMC PS. The results suggested that the ALC/AMC PS appears to be more reliable than the NLR and LMR and may provide additional prognostic information when used in conjunction with the International Prognostic Index. -Hong Chen, MD hen, MD, nd Yi-Ying Wu, MD absolute monocyte count prognostic score, AMC = absolute monocyte count, CIs = confidence intervals, DLBCL = diffuse large B-cell lymphoma, ECOG PS = Eastern Cooperative Oncology LMR = lymphocyte/monocyte ratio, NLR = neutrophil/lymphocyte ratio, OS = overall survival, PFS = progression-free survival. INTRODUCTION T he clinical outcome of diffuse large B-cell lymphoma (DLBCL) has been significantly improved by the introduction of rituximab (R). Current prognostic models, including the International Prognostic Index (IPI), incorporate patient and tumor characteristics. However, with improved outcomes, the identification of a high-risk subset of patients with an anticipated 5-year survival of less than 50% remains a challenge with the use of these models alone. Over the past 2 decades, many studies have been conducted to identify novel biomarkers characterizing patients with a poor prognosis. Gene expression profiling (GEP), mutational analyses, immunohistochemistry (IHC)-based detection, and early interim analysis with positron emission tomography (PET) have provided crucial information about several new prognostic parameters for the response to therapy in DLBCL. Although they are promising, many of these methods are costly, difficult to obtain, not easily interpreted, and require further validation. Therefore, the evaluation of a patient’s prognosis using simple, inexpensive, and easily interpreted clinical parameters warrants investigation. The complete blood cell (CBC) count and its components may be the most useful tools available. As a surrogate marker of inflammation, the baseline neutrophil count has been associated with survival in patients with malignancies. The absolute lymphocyte count (ALC) is a marker of host immunity and has also been reported to be a prognostic factor for survival in patients with DLBCL at diagnosis or after first relapse. Additionally, monocytes and lymphoma-associated macrophages (LAMs), which are considered immunologically relevant and are regarded to be a surrogate marker of the tumor microenvironment, have also recently been reported to be prognostic factors in DLBCL. Some applications derived from these blood cells have also been studied, including the ratio (NLR), lymphocyte/monocyte the absolute lymphocyte count/absolute stic score (ALC/AMC PS); all of these www.md-journal.com | 1 items were considered to be independent prognostic factors in DLBCL patients. Therefore, we reviewed the clinicopathological characteristics of the patients with DLBCL in our institution and collected easily obtained data such as the NLR, LMR, and ALC/ AMC PS. A retrospective analysis was performed in Taiwanese patients with DLBCL at the Tri-Service General Hospital. MATERIALS AND METHODS