Elevated Neutrophil: Lymphocyte Ratio Does Not Predict Survival In Multiple Myeloma Patients

Abstract

Background Cancer associated inflammation is one of the key determinants of outcome in patients with cancer. An elevated neutrophil: lymphocyte ratio (NLR) has been identified as a predictor of worse survival in patients with various solid tumors compared to hematologic malignancies but no reports yet examined its impact on multiple myeloma. The aim of this study was to examine the prognostic value of an elevated NLR in multiple myeloma. Methods We had approval by our institutional review board to collect the data on patients diagnosed with multiple myeloma at Staten Island University Hospital between year 2000 and 2012 identified from our local cancer database. Data on demographics, conventional prognostic markers, laboratory analyzes including blood count results, and histopathology were collected and analyzed. A cox proportional survival analysis was carried out to assess the relationship between NLR and mortality. NLR was assessed as a continuous variable as well as categorical variable (quartile 0.5-1.5, 1.6-2.2, 2.3-3.8, and 3.9-22.3). Results A total of 96 patients were identified with a median age at diagnosis of 70 (IQR of 61 to 79) years. The median neutrophil count was 3.5 (2.5—5.1) x 10-9/liters, median lymphocyte count 1.5 (1.05-2.4) × 10-9/liters, while the NLR was 2.28 (1.53-3.88). The median overall survival was 147.5 weeks, IQR (88.5-320). NLR did not prove to be a significant predictor of death as a continuous variable (0.95 (0.85-1.06), p =0.35). Furthermore, there was no significant difference in survival with any of the quartiles of NLR. Compare to lowest quartile of NLR, Hazards ratio for the consecutive quartiles were 1.25 (0.56-2.79, p 0.55), 1.36 (0.61-3.04, p=0.45) and 0.89 (0.36-2.22, p=0.80). Conclusion NLR does not appear to offer useful predictive ability for outcome and survival in multiple myeloma patients. Our study is limited with small sample size, further studies are needed to validate our results. Disclosures: No relevant conflicts of interest to declare.

The Prognostic Significance of the Neutrophil-to-Lymphocyte Ratio in Patients with Multiple Myeloma: A Pilot Study

“…In our study, no significant correlation was found between PLT level and both mortality and OS in patients with MM. However, similar to our study, some studies reported no significant relationship between the PLT level and OS (5,15).…”

“…In our study, there was no relationship between the NLR and both mortality and OS in patients with MM. However, similar to our study, no significant correlation between NLR and mortality and OS was demonstrated in other studies (9,15).…”

Is the platelet-to-lymphocyte ratio a new prognostic marker in multiple myeloma?

“…They defended their result on the basis of small sample size (96 patients). [ 21 ] We also did not find any statistical significant relationship between OS and NLR groups, although the survival seems to be better in low NLR group but not statistically significant (5-year OS: 66% in low NLR, 54% in high NLR, P = 0.80). Due to these discrepancies, we think that prospective studies are needed, to clarify the effect of NLR on OS.…”

“…In the literature, there are some discrepancies about the effect of NLR on OS in patients with hematologic malignancies. [ 10 11 20 21 ] Wongrakpanich et al . found a significant relationship between high NLR and OS in the patients with MM (NLR cutoff point 2.59).…”

The effect of haemoglobin, albumin, lymphocyte and platelet score on the prognosis in patients with multiple myeloma

“…The increased NLR levels of autologous‐transplanted patients with myeloma at day 100 (after reinfusion) also predicted reduced survival 12 . However, there are studies in the literature suggesting that the increased NLR may not be able to predict survival in patients with multiple myeloma 32,33 . In our study, increased NLR group presented significantly longer OS and PFS.…”