Clinical Value of Absolute Lymphocyte Counts before Bortezomib-Dexamethasone Therapy in Relapsed Multiple Myeloma Patients

Abstract

A high absolute lymphocyte count (ALC) at diagnosis is known as a surrogate marker of favorable prognosis in newly diagnosed multiple myeloma (MM). Recent studies showed tumor sensitization and enhanced cytotoxicity of bortezomib. We hypothesized that a high ALC before bortezomib treatment would contribute to tumor sensitization and activated cytotoxicity of bortezomib in relapsed MM. Ninety-seven relapsed MM patients who underwent bortezomib-dexamethasone (Vel-Dex) therapy were analyzed. Median follow-up duration was 21 months and median age was 61 years. Complete response (CR) and very good partial response (VGPR) after 2 cycles of Vel-Dex therapy were higher in the high-ALC group (≧1.1 × 10⁹/l) (CR + VGPR 50.0% in the high-ALC group vs. 10.4% in the low-ALC group, p = 0.001), and stable disease (SD) rate was lower in the high-ALC group (SD 11.8% in the high-ALC group vs. 44.8% in the low-ALC group, p < 0.001). In the univariate analysis, the low-ALC group before therapy was associated with shorter progression-free survival (PFS) [hazard ratio (HR), 2.780; 95% confidence interval (95% CI) 1.703–4.536, p < 0.001]. Multivariate analysis revealed that a low ALC represented an independent predictive factor for PFS (HR 1.937, 95% CI 1.168–3.212, p = 0.010). A low ALC just before Vel-Dex therapy was associated with a poor prognosis in relapsed MM.

Prognostic Significance of Absolute Lymphocyte Count/Absolute Monocyte Count Ratio at Diagnosis in Patients with Multiple Myeloma

“…Although ALC did not have statistical significance in multivariate analysis due to the relatively small sample size, our results are in agreement with previous reports showing that a high ALC is associated with better prognosis in newly diagnosed MM (cut-off point, 1,400 cells/µL; the same as that used our study),3 relapsed MM after Vel-Dex therapy (cut-off point, 1,100 cells/µL)23 and other lymphomas 24…”

Absolute lymphocyte count as a prognostic marker in newly diagnosed multiple myeloma patients

“…It has also been reported that the levels of CD19 + and naive CD4 + cells can distinguish between subgroups of MM patients based on survival and that decreased level of CD4 + cells in the marrow lymphocyte population correlates with progressive disease [4]. This correlation was also found during the course of the disease, after two years of therapy, or in relapsed MM patients [10]. Patients with higher level of CD19 + cells were also found to have decreased incidence, severity, and mortality from infections [11].…”

Significance of the absolute lymphocyte/monocyte ratio as a prognostic immune biomarker in newly diagnosed multiple myeloma

“…Retrospective studies in MM have shown that a higher ALC before bortezomib therapy is associated with better overall survival (OS). 10 Furthermore, in MM patients undergoing autologous stem cell transplant (ASCT), both higher pre-ASCT ALC levels and early post-ASCT recovery of ALC were independent prognostic factors for OS. 11 Taken together, the ratio of ALC to AMC may represent the relative strength of the host immune system (that is, ALC) to tumor-induced immune dysfunction (that is, AMC, reflective of TAMs).…”