Peripheral blood absolute lymphocyte/monocyte ratio as a useful prognostic factor in diffuse large B-cell lymphoma in the rituximab era.

Abstract

OBJECTIVES:

The tumor microenvironment, including tumor-infiltrating lymphocytes and myeloid-derived cells, is an important factor in the pathogenesis and clinical behavior of malignant lymphoma. However, the prognostic significance of peripheral lymphocytes and monocytes in lymphoma remains unclear.

METHODS:

We evaluated the prognostic impact of the absolute lymphocyte count (ALC), absolute monocyte count (AMC), and lymphocyte/monocyte ratio (LMR) in 359 diffuse large B-cell lymphoma (DLBCL) patients treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP).

RESULTS:

The median follow-up time of the surviving patients was 58 months. Low ALC and an elevated AMC were both associated with poor survival rates. Receiver operating characteristic curve analysis showed that LMR was the best predictor of survival, with 4.0 as the cutoff point. Patients with LMR ≤4.0 were more likely to have an aggressive tumor, and this was associated with poor treatment responses. Patients with LMR ≤4.0 at diagnosis had significantly poorer overall survival (OS) and progression-free survival (PFS) than those with LMR >4.0. Multivariate analysis, which included prognostic factors of the International Prognostic Index, showed LMR ≤4.0 to be an independent predictor for the OS (hazard ratio [HR], 2.507; 95% confidence interval [CI], 1.255-5.007; P = 0.009) and PFS (HR, 2.063; 95% CI, 1.249-3.408; P = 0.005).

CONCLUSIONS:

The LMR at diagnosis, as a simple index which reflects host systemic immunity, predicts clinical outcomes in DLBCL patients treated with R-CHOP.

• Authors: Reina Watanabe, Naoto Tomita, Megumi Itabashi, Daisuke Ishibashi, Eri Yamamoto, Satoshi Koyama, Kazuho Miyashita, Hiroyuki Takahashi, Yuki Nakajima, Yukako Hattori, Kenji Motohashi, Hirotaka Takasaki, Rika Ohshima, Chizuko Hashimoto, Etsuko Yamazaki, Katsumichi Fujimaki, Rika Sakai, Shin Fujisawa, Shigeki Motomura, Yoshiaki Ishigatsubo
• Journal: European journal of haematology (Eur J Haematol) Vol. 92 Issue 3 Pg. 204-10 (Mar 2014) ISSN: 1600-0609 [Electronic] England
• PMID: 24283206 (Publication Type: Journal Article)
• Copyright: © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Chemical References

• Antibodies, Monoclonal, Murine-Derived
• R-CHOP protocol
• Rituximab
• Vincristine
• Doxorubicin
• Cyclophosphamide
• Prednisone

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Antibodies, Monoclonal, Murine-Derived (therapeutic use)
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Cohort Studies
• Cyclophosphamide (therapeutic use)
• Disease-Free Survival
• Doxorubicin (therapeutic use)
• Female
• Humans
• Lymphocyte Count
• Lymphocytes (cytology)
• Lymphoma, Large B-Cell, Diffuse (diagnosis, drug therapy)
• Male
• Middle Aged
• Monocytes (cytology)
• Prednisone (therapeutic use)
• Prognosis
• ROC Curve
• Rituximab
• Treatment Outcome
• Vincristine (therapeutic use)
• Young Adult