The absolute monocyte and lymphocyte prognostic score predicts survival and identifies high-risk patients in diffuse large-B-cell lymphoma

Abstract

Despite the use of modern immunochemotherapy regimens, almost 50% of patients with diffuse large-B-cell lymphoma will relapse. Current prognostic models, including the International Prognostic Index, incorporate patient and tumor characteristics. In contrast, recent observations show that variables related to host adaptive immunity and the tumor microenvironment are significant prognostic variables in non-Hodgkin lymphoma. Therefore, we retrospectively examined the absolute monocyte and lymphocyte counts as prognostic variables in a cohort of 366 diffuse large-B-cell lymphoma patients who were treated between 1993 and 2007 and followed at a single institution. The absolute monocyte and lymphocyte counts in univariate analysis predicted progression-free and overall survival when analyzed as continuous and dichotomized variables. On multivariate analysis performed with factors included in the IPI, the absolute monocyte and lymphocyte counts remained independent predictors of progression-free and overall survival. Therefore, the absolute monocyte and lymphocyte counts were combined to generate a prognostic score that identified patients with an especially poor overall survival. This prognostic score was independent of the IPI and added to its ability to identify high-risk patients.

Prognostic impact of absolute lymphocyte count/absolute monocyte count ratio and prognostic score in patients with nasal-type, extranodal natural killer/T-cell lymphoma

“…Wilcox et al 19 first described the role of AMC/ALC prognostic score in diffuse large-B-cell lymphoma. Subsequent evidence also investigated the prognostic value of ALC/AMC prognostic score in diffuse large-Bcell lymphoma.…”

“…30,36,37 Antecedent evidence verified that ALC and AMC were parameters to predict outcomes in several types of cancer. [14][15][16][17][18][19][20][38][39][40][41][42] ALC and AMC have been studied as combined factors in Hodgkin's lymphoma and diffuse large B-cell lymphoma. 19,[21][22][23][24][25][26] Results showed that ALC/AMC ratio and AMC/ALC prognostic scores seemed to be associated with outcomes.…”

“…[21][22][23][24] ALC/AMC prognostic score was calculated in accordance with Wilcox's study. 19 In general, the patients were classified into three risk groups: low risk (normal ALC and AMC), intermediate risk (low ALC or high AMC), and high risk (low ALC and high AMC). Computed tomography (CT) or magnetic resonance (MR) of nasopharynx, neck, chest, and whole abdomen or positron emission tomography/CT (PET/CT) was used to evaluate patients' disease.…”

“…Moreover, the value of the incorporation of ALC and AMC has been explored and several studies revealed that ALC/AMC ratio [21][22][23][24] and ALC/AMC prognostic score (low risk and normal ALC and AMC; intermediate risk, low ALC, or high AMC; high risk, low ALC, and high AMC) 19,25,26 were related to survival in certain types of lymphomas. Although there are definite results in these cancers, the role of ALC/ AMC ratio and ALC/AMC prognostic score 20 in ENKTL is still unclear and requires validation in other patient cohorts.…”

“…Previous studies showed that absolute lymphocyte count (ALC) [14][15][16][17][18][19] and peripheral blood absolute monocyte count (AMC) 19,20 at diagnosis can evaluate the prognosis in some lymphoid and hematological malignancies. Moreover, the value of the incorporation of ALC and AMC has been explored and several studies revealed that ALC/AMC ratio [21][22][23][24] and ALC/AMC prognostic score (low risk and normal ALC and AMC; intermediate risk, low ALC, or high AMC; high risk, low ALC, and high AMC) 19,25,26 were related to survival in certain types of lymphomas.…”