Can the prognosis of mantle cell lymphoma be predicted by simple CBC counts?

Abstract

Mantle cell lymphoma (MCL) exhibits a heterogenous clinical course. The MCL International Prognostic Index (MIPI) is the most commonly used risk classification system in MCL. However, it does not contain a parameter associated with the tumor microenvironment. The aim of this study was to develop a more powerful prognostic index by evaluating the absolute monocyte count (AMC), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) at diagnosis in conjunction with the clinical and laboratory parameters. The data of 96 MCL patients with newly diagnosed from January 2014 to December 2018 were retrospectively evaluated in this study. The AMC, NLR, and PLR cut-off values were determined using the receiver operating characteristic (ROC) analysis. The clinical behavior and results of the disease exhibited significant variation in high and low value groups at the time of diagnosis. In univariate analysis, the AMC ≥ 580, NLR ≥ 2.43, and PLR ≥ 120.85 were determined as negative prognostic factors for 5-year progression free survival (PFS) (AMC: PFS, P < .001; NLR: PFS, P < .001; PLR: PFS, P < .001) and for 5-year overall survival (OS) ( P < .001, P < .001, P < .001, respectively). Beta-2 microglobulin (B2-MG), and MIPI for PFS, and for OS were found to be independent risk factors in the multivariate analysis (for PFS: P = .006, P = .002, respectively; and for OS: P = .007, P = .001, respectively). The 5-year OS was 20% in the group with B2-MG ≥ 3.5. The patients in high-risk MIPI group had poorer 5-year OS (median OS: 40 months, P < .001). The results stated that the use of B2-MG in conjunction with MIPI was a more sensitive method in determining the prognosis in MCL (median OS: 12 months in high-risk MIPI group with a B2-MG ≥3.5, P < .001). Additionally, it was found that parameters reflecting the tumor microenvironment such as AMC, NLR, and PLR increased the risk of progression in MCL. In view of these findings, in addition B2-MG to the MIPI to create a more sensitive prognostic scoring system may provide an insight into personalization of treatment with early recognition of patients with poor prognosis.

<p>The Neutrophil to Lymphocyte and Lymphocyte to Monocyte Ratios as New Prognostic Factors in Hematological Malignancies – A Narrative Review</p>

“…Neutrophils exhibit anti-tumor activity, but also suppress the cytolytic activity of immune cells such as lymphocytes. 32 They secrete multiple cytokines such as: interleukin-2 (IL-2), interleukin-10 (IL-10), tumor necrosis factor α (TNF α), which are well known promotors of tumorigenesis. This may be one of the reasons why upwards of 15% malignancies worldwide are initiated by infections.…”

“…18,21,22 microenvironment and host's immunologic response. 32 Numerous studies have proved that inflammation plays a crucial role in tumor initiation, growth and progression. 41 There exists plenty of evidence that systemic inflammatory response is a determinant of prognosis in patients with malignant neoplasms.…”

“…In Hoster et al 61 61 Although MIPI provides important prognostic data, it is not always sufficient in evaluation of clinical course of the disease. 32 MIPI has been introduced for advanced staged patients, in pre-rituximab era. 62 Ki-67 index exhibits some additional discriminatory application, as well as gene expression profiling.…”

“…65 In contrary, in George et al 66 study, the connection between AMC and the outcome was not observed. 32,66 The first and the only study aimed at investigating NLR prognostic significance in MCL was published by Haydaroglu et al 32 The absolute monocyte count (AMC), NLR, PLR at diagnosis of mantle cell lymphoma has been evaluated in 96 patients. AMC>/=580, NLR >/=2,43 and PLR>/=120,85 turned out to be negative prognostic factors for 5-year PFS.…”

“…However, NLR has not be found as an independent risk factor for PFS and OS. 32 Also, prognostic value of peripheral blood lymphocyte subsets counts has been thoroughly analyzed. 62 One and only research considering the subject was carried out on 68 MCL patients.…”