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Duminuco A, Romano A, Ferrarini I, Santuccio G, Chiarenza A, Figuera A, Caruso LA, Motta G, Palumbo GA, Mogno C, Moioli A, Di Raimondo F, Visco C. Monocyte-to-platelets ratio (MPR) at diagnosis is associated with inferior progression-free survival in patients with mantle cell lymphoma: a multi-center real-life survey. Ann Hematol 2024; 103:3043-3052. [PMID: 38630129 DOI: 10.1007/s00277-024-05752-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/08/2024] [Indexed: 07/28/2024]
Abstract
Mantle cell lymphoma (MCL) pathogenesis is strongly related to the role of the tumor immune microenvironment (TIME) in which MCL cells proliferate. TIME cells can produce growth signals influencing MCL cells' survival and exert an antitumoral immune response suppression. The activity of TIME cells might be mirrored by some ratios of peripheral blood cell subpopulations, such as the monocyte-to-platelet ratio (MPR). We reviewed the clinical features of 165 consecutive MCL patients newly diagnosed and not eligible for autologous stem cell transplantation (both for age or comorbidities) who accessed two Italian Centers between 2006 and 2020. MPR was calculated using data obtained from the complete blood cell count at diagnosis before any cytotoxic treatment and correlated with PFS. Univariate analysis showed that MPR ≥ 3 was associated with inferior PFS (p = 0.02). Multivariate analysis confirmed that MPR ≥ 3, LDH > 2.5 ULN, and bone marrow involvement were significant independent variables in predicting PFS. For these reasons, MPR ≥ 3 seems the most promising prognostic factor in patients with MCL, and it could be considered a variable in new predictive models.
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Affiliation(s)
- Andrea Duminuco
- Hematology with BMT Unit, A.O.U. "G. Rodolico-San Marco", Catania, Italy.
- Hematology with BMT Unit - A.O.U. Policlinico "G. Rodolico-San Marco", Via Santa Sofia, 78, Catania, 95123, Italy.
| | - Alessandra Romano
- Hematology with BMT Unit, A.O.U. "G. Rodolico-San Marco", Catania, Italy
- Dipartimento di Specialità Medico-Chirurgiche, CHIRMED, University of Catania, Catania, Italy
| | - Isacco Ferrarini
- Dipartimento di Scienze Mediche Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", University of Catania, Catania, Italy
| | | | - Annalisa Chiarenza
- Hematology with BMT Unit, A.O.U. "G. Rodolico-San Marco", Catania, Italy
| | - Amalia Figuera
- Hematology with BMT Unit, A.O.U. "G. Rodolico-San Marco", Catania, Italy
| | | | - Giovanna Motta
- Hematology with BMT Unit, A.O.U. "G. Rodolico-San Marco", Catania, Italy
| | - Giuseppe Alberto Palumbo
- Hematology with BMT Unit, A.O.U. "G. Rodolico-San Marco", Catania, Italy
- Dipartimento di Scienze Mediche Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Carlo Mogno
- Department of Engineering for Innovation Medicine, Section of Hematology, AOUI VR, University of Verona, Verona, Italy
| | - Alessia Moioli
- Department of Engineering for Innovation Medicine, Section of Hematology, AOUI VR, University of Verona, Verona, Italy
| | - Francesco Di Raimondo
- Hematology with BMT Unit, A.O.U. "G. Rodolico-San Marco", Catania, Italy
- Dipartimento di Specialità Medico-Chirurgiche, CHIRMED, University of Catania, Catania, Italy
| | - Carlo Visco
- Department of Engineering for Innovation Medicine, Section of Hematology, AOUI VR, University of Verona, Verona, Italy
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Lecot L, Desmas‐Bazelle I, Benjamin S, De Fornel P, Ponce F, Kornya M, Desquilbet L, Beaudu‐Lange C, Ibisch C, Sayag D, Benchekroun G, Béguin J. Descriptive analysis and prognostic factors in cats with myeloma-related disorders: A multicenter retrospective study of 50 cases. J Vet Intern Med 2024; 38:1693-1705. [PMID: 38517293 PMCID: PMC11099758 DOI: 10.1111/jvim.17051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 03/08/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Myeloma-related disorders (MRDs) are rare and poorly documented neoplasms of cats. HYPOTHESIS/OBJECTIVES To describe clinical, clinicopathologic, and imaging findings, response to treatment, and survival time and to identify factors associated with shorter outcomes in cats with MRD. ANIMALS Fifty cats with a diagnosis of MRD. METHODS Cats with paraproteinemia confirmed by serum protein electrophoresis (SPE) and either intramedullary plasmacytosis >10%, marked cytonuclear atypia with intramedullary plasmacytosis that ranged between 5% and 10%, or cytologically or histologically confirmed visceral infiltration were retrospectively included from several veterinary referral centers. RESULTS Bone marrow plasmacytosis and splenic or hepatic involvement were present in 17/27 cats (63%), 36/42 cats (86%), and 27/38 cats (71%), respectively. Anemia was reported in 33/49 cats (67%) and thrombocytopenia in 16/47 cats (34%). Some of the treatments that the cats received included melphalan and prednisolone (n = 19), cyclophosphamide and prednisolone (n = 10), chlorambucil and prednisolone (n = 4), prednisolone (n = 4), or other (n = 4). The overall response rates to melphalan, cyclophosphamide, and chlorambucil in combination with prednisolone were 87%, 90%, and 100%, respectively. Adverse events to melphalan or cyclophosphamide occurred in 65% and 23% of cats, respectively. Median survival time was 122 days (range, 0-1403) and was not significantly associated with chemotherapy protocol. Anemia (hazard ratio [HR], 3.1; 95% confidence interval [CI], 1.0-9.8) and thrombocytopenia (HR, 2.7; 95% CI, 1.2-6.0) were risk factors for shorter survival. CONCLUSIONS AND CLINICAL IMPORTANCE Our study confirmed the guarded prognosis of MRD in cats and identified risk factors for shorter survival times.
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Affiliation(s)
- Lorris Lecot
- Ecole Nationale Vétérinaire d'Alfort–CHUVAService de Médecine InterneMaisons‐AlfortFrance
- Université de Lyon, VetAgro Sup, Service de médecine interneMarcy l'EtoileFrance
| | | | | | | | - Frédérique Ponce
- Université de Lyon, VetAgro Sup, Service de cancérologie, UR ICEMarcy l'EtoileFrance
| | - Matthew Kornya
- Ontario Veterinary CollegeUniversity of GuelphGuelphOntarioCanada
| | - Loïc Desquilbet
- Ecole nationale vétérinaire d'Alfort, IMRBMaisons‐AlfortFrance
| | | | - Catherine Ibisch
- Nantes‐Atlantic College of Veterinary Medicine and Food Sciences (Oniris)NantesFrance
| | | | - Ghita Benchekroun
- Ecole Nationale Vétérinaire d'Alfort–CHUVAService de Médecine InterneMaisons‐AlfortFrance
- Ecole Nationale Vétérinaire d'AlfortUniversité Paris Est Créteil, INSERM, IMRBMaisons‐AlfortFrance
| | - Jérémy Béguin
- Ecole Nationale Vétérinaire d'Alfort–CHUVAService de Médecine InterneMaisons‐AlfortFrance
- UMR1161 VIROLOGIE, INRAE, Ecole Nationale Vétérinaire d'Alfort, ANSESUniversité Paris‐EstMaisons‐AlfortFrance
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3
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Ren L, Xu J, Li J, Xu T, Yang Y, Wang W, Ren Y, Gu S, Chen C, Wei Z, Zhuang J, Wang Z, Ji L, Cheng L, Wang W, Cheng Z, Ke Y, Yuan L, Liu P. A prognostic model incorporating inflammatory cells and cytokines for newly diagnosed multiple myeloma patients. Clin Exp Med 2023; 23:2583-2591. [PMID: 36639599 DOI: 10.1007/s10238-023-00992-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023]
Abstract
Peripheral blood cell counts and cytokines can be used as predictors of multiple myeloma (MM) patients' outcomes. 313 newly diagnosed MM patients treated with novel agents were divided into training and validation cohorts. We selected the common peripheral blood cell counts, including the lymphocyte/monocyte ratio (LMR), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR), systemic inflammation response index (SIRI), and serum cytokines which contained tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-2 receptor (IL-2R), interleukin-8 (IL-8), interleukin-6 (IL-6), and interleukin-10 (IL-10) as related variables. The least absolute shrinkage and selection operator (LASSO) regression was conducted to sort the predictor variables in the training cohort, and then the developed nomogram was assessed in the training and validation cohort. Our study showed that SIRI, PLR, and IL-8 were independent prognostic factors for the survival of MM patients. Patients with lower SIRI (≤ 0.87) had superior survival than patients with higher SIRI (> 0.87). Further, according to the LASSO regression, a nomogram embracing LMR (> 3.78), SIRI (> 0.87), PLR (≤ 106.44), and IL-8 was established. The nomogram demonstrated a better correlation with the outcomes of MM patients in the training cohort than International Staging System (ISS) and Revised-International Staging System (R-ISS). The same results were verified in the validation cohort. The nomogram incorporating inflammatory cells and cytokines could be a helpful tool to stratify MM patients in the era of novel agents.
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Affiliation(s)
- Liang Ren
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Jiadai Xu
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Jing Li
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Tianhong Xu
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Yang Yang
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Wenjing Wang
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Yuhong Ren
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Shiyang Gu
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Chen Chen
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Zheng Wei
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Jingli Zhuang
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Zhimei Wang
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Lili Ji
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Luya Cheng
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Weiguang Wang
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Zhixiang Cheng
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Yang Ke
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Ling Yuan
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Peng Liu
- Department of Hematology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
- Cancer Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
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Di Raimondo C, Lombardo P, Tesei C, Esposito F, Meconi F, Secchi R, Lozzi F, Monopoli A, Narducci MG, Scala E, Angeloni C, De Stefano A, Rahimi S, Bianchi L, Cantonetti M. Role of Neutrophil-to-Lymphocyte Ratio (NLR) in Patients with Mycosis Fungoides. Diagnostics (Basel) 2023; 13:diagnostics13111979. [PMID: 37296831 DOI: 10.3390/diagnostics13111979] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/28/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The neutrophil/lymphocyte ratio (NLR) at baseline has been demonstrated to correlate with higher stages of disease and to be a prognostic factor in numerous cancers. However, its function as a prognostic factor for mycosis fungoides (MF) has not been yet clarified. OBJECTIVE Our work aimed to assess the association of the NLR with different stages of MF and to outline whether higher values of this marker are related to a more aggressive MF. METHODS We retrospectively calculated the NLRs in 302 MF patients at the moment of diagnosis. The NLR was obtained using the complete blood count values. RESULTS The median NLR among patients with early stage disease (low-grade IA-IB-IIA) was 1.88, while the median NLR for patients with high-grade MF (IIB-IIIA-IIIB) was 2.64. Statistical analysis showed positive associations of advanced MF stages with NLRs higher than 2.3. CONCLUSIONS Our analysis demonstrates that the NLR represents a cheap and easily available parameter functioning as a marker for advanced MF. This might guide physicians in recognizing patients with advanced stages of disease requiring a strict follow-up or an early treatment.
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Affiliation(s)
- Cosimo Di Raimondo
- Department of Dermatology, University of Roma Tor Vergata, 00133 Rome, Italy
| | - Paolo Lombardo
- Istituto Dermopatico dell'Immacolata, IDI-IRCCS, 00167 Rome, Italy
| | - Cristiano Tesei
- Department of Hematology, University of Roma Tor Vergata, 00133 Rome, Italy
| | - Fabiana Esposito
- Department of Hematology, University of Roma Tor Vergata, 00133 Rome, Italy
| | - Federico Meconi
- Department of Hematology, University of Roma Tor Vergata, 00133 Rome, Italy
| | - Roberto Secchi
- Department of Hematology, University of Roma Tor Vergata, 00133 Rome, Italy
| | - Flavia Lozzi
- Department of Dermatology, University of Roma Tor Vergata, 00133 Rome, Italy
| | | | | | - Enrico Scala
- Istituto Dermopatico dell'Immacolata, IDI-IRCCS, 00167 Rome, Italy
| | - Cecilia Angeloni
- Department of Diagnostic Imaging and Interventional Radiology, University of Roma Tor Vergata, 00133 Rome, Italy
| | - Alberto De Stefano
- Volunteers Association of Fondazione Policlinico "Tor Vergata", 00133 Rome, Italy
| | - Siavash Rahimi
- Istituto Dermopatico dell'Immacolata, IDI-IRCCS, 00167 Rome, Italy
| | - Luca Bianchi
- Department of Dermatology, University of Roma Tor Vergata, 00133 Rome, Italy
| | - Maria Cantonetti
- Istituto Dermopatico dell'Immacolata, IDI-IRCCS, 00167 Rome, Italy
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Shimazu Y, Kanda J, Kosugi S, Ito T, Kaneko H, Imada K, Shimura Y, Fuchida SI, Fukushima K, Tanaka H, Yoshihara S, Ohta K, Uoshima N, Yagi H, Shibayama H, Yamamura R, Tanaka Y, Uchiyama H, Onda Y, Adachi Y, Hanamoto H, Takahashi R, Matsuda M, Miyoshi T, Takakuwa T, Hino M, Hosen N, Nomura S, Shimazaki C, Matsumura I, Takaori-Kondo A, Kuroda J. Efficacy of elotuzumab for multiple myeloma in reference to lymphocyte counts and kappa/lambda ratio or B2 microglobulin. Sci Rep 2023; 13:5159. [PMID: 36991096 PMCID: PMC10060246 DOI: 10.1038/s41598-023-32426-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
AbstractNovel therapeutic drugs have dramatically improved the overall survival of patients with multiple myeloma. We sought to identify the characteristics of patients likely to exhibit a durable response to one such drug, elotuzumab, by analyzing a real-world database in Japan. We analyzed 179 patients who underwent 201 elotuzumab treatments. The median time to next treatment (TTNT) with the 95% confidence interval was 6.29 months (5.18–9.20) in this cohort. Univariate analysis showed that patients with any of the following had longer TTNT: no high risk cytogenic abnormalities, more white blood cells, more lymphocytes, non-deviated κ/λ ratio, lower β2 microglobulin levels (B2MG), fewer prior drug regimens, no prior daratumumab use and better response after elotuzumab treatment. A multivariate analysis showed that TTNT was longer in patients with more lymphocytes (≥ 1400/μL), non-deviated κ/λ ratio (0.1–10), lower B2MG (< 5.5 mg/L) and no prior daratumumab use. We proposed a simple scoring system to predict the durability of the elotuzumab treatment effect by classifying the patients into three categories based on their lymphocyte counts (0 points for ≥ 1400/μL and 1 point for < 1400/μL) and κ/λ ratio (0 points for 0.1–10 and 1 point for < 0.1 or ≥ 10) or B2MG (0 points for < 5.5 mg/L and 1 point for ≥ 5.5 mg/L). The patients with a score of 0 showed significantly longer TTNT (p < 0.001) and better survival (p < 0.001) compared to those with a score of 1 or 2. Prospective cohort studies of elotuzumab treatment may be needed to validate the usefulness of our new scoring system.
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Zhang L, Chen S, Wang W, Wang Y, Liang Y. Inflammatory and Nutritional Scoring System for Predicting Prognosis in Patients with Newly Diagnosed Multiple Myeloma. J Inflamm Res 2023; 16:7-17. [PMID: 36636247 PMCID: PMC9831084 DOI: 10.2147/jir.s390279] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 12/24/2022] [Indexed: 01/06/2023] Open
Abstract
Purpose We aimed to assess the prognostic value of pretreatment inflammatory and nutritional parameters for predicting overall survival (OS) in patients with newly diagnosed multiple myeloma (NDMM), and to build a new scoring system using the most important variables. Methods We retrospectively analyzed baseline clinical and laboratory data for patients with NDMM, who were randomly grouped into training and validation cohorts at a ratio of 8:2. The Inflammatory Nutritional Score (INS) was developed based on the least absolute shrinkage and selection operator (LASSO) Cox regression. The INS and other independent prognostic factors were entered into a multivariate Cox model and merged to generate a nomogram model for predictive optimization. Performance and predictive accuracy were assessed using the concordance index (C-index), calibration plots, and time-dependent receiver operating characteristic (ROC) curves. Results In total, 442 eligible patients were enrolled. Six inflammatory/nutritional variables, including the Nutritional Risk Index (NRI), body mass index (BMI), neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), platelet-lymphocyte ratio (PLR), and albumin-alkaline phosphatase ratio (AAPR), were integrated to construct the INS using the LASSO Cox model. The predictive nomogram constructed following the multivariate Cox analysis included INS, performance status, lactate dehydrogenase, age, and C-reactive protein. The model exhibited good predictive performance, with a C-index of 0.708 in the training cohort and 0.749 in the validation cohort. Moreover, the calibration curves also demonstrated excellent consistency between predicted and observed survival in both cohorts. In the time-dependent ROC analysis, our nomogram model exhibited better performance than other staging systems for multiple myeloma. Conclusion The INS represents an independent prognostic signature in patients with NDMM. Our novel nomogram based on INS may aid in predicting survival probability and stratifying risk.
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Affiliation(s)
- Limei Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People’s Republic of China,Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People’s Republic of China
| | - Shuzhao Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People’s Republic of China,Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People’s Republic of China
| | - Weida Wang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People’s Republic of China,Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People’s Republic of China
| | - Yun Wang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People’s Republic of China,Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People’s Republic of China
| | - Yang Liang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People’s Republic of China,Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People’s Republic of China,Correspondence: Yang Liang; Yun Wang, Department of Hematologic Oncology, Sun Yat-sen University Cancer, State Key Laboratory of Oncology in South China, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People’s Republic of China, Email ;
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Mikulski D, Kościelny K, Nowicki M, Wawrzyniak E, Kalwas M, Kowalik M, Pryt M, Sęczkowska E, Świątek A, Wierzbowska A, Fendler W. Neutrophil to lymphocyte ratio (NLR) impact on the progression-free survival and overall survival of multiple myeloma patients treated with high-dose chemotherapy and autologous stem cell transplantation. Leuk Lymphoma 2023; 64:98-106. [PMID: 36318865 DOI: 10.1080/10428194.2022.2136946] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
High-dose chemotherapy with autologous stem-cell transplantation (ASCT) remains the standard of care in multiple myeloma (MM) patients. This retrospective study aimed to assess the impact of neutrophil-to-lymphocyte ratio (NLR) and other complete blood count (CBC)-based predictors on PFS and OS of transplant-eligible MM patients. The CBC-based biomarkers were evaluated in a single-center cohort of 176 MM patients at three time points: at the diagnosis, the time of ASCT, and +100 d after ASCT. Univariable and multivariable Cox's regression analyses and Kaplan-Meier estimate were used in statistical analysis. NLR at ASCT (HR 1.15, 95% CI: 1.05-1.26) and hemoglobin at ASCT (HR 0.80, 95% CI: 0.68-0.94) were independent factors influencing PFS. In the model for OS, the only statistically significant factors were NLR at ASCT (HR 1.15, 95% CI: 1.04-1.27), bortezomib administration prior to ASCT (HR 0.52, 95% CI: 0.33-0.83) and age at diagnosis (HR 1.03, 95% CI: 1.00-1.06). NLR at ASCT is an independent predictive factor in MM patients undergoing ASCT.
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Affiliation(s)
- Damian Mikulski
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland.,Department of Hematology, Copernicus Memorial Hospital in Lodz Comprehensive Cancer Center and Traumatology, Lodz, Poland
| | - Kacper Kościelny
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Mateusz Nowicki
- Department of Hematology, Copernicus Memorial Hospital in Lodz Comprehensive Cancer Center and Traumatology, Lodz, Poland.,Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Ewa Wawrzyniak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Marta Kalwas
- Department of Pathology, Chair of Oncology, Medical University of Lodz, Lodz, Poland
| | - Monika Kowalik
- Department of Hematology, Copernicus Memorial Hospital in Lodz Comprehensive Cancer Center and Traumatology, Lodz, Poland
| | - Mateusz Pryt
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Emilia Sęczkowska
- Department of Anesthesiology and Intensive Medical Therapy, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Agnieszka Świątek
- Department of Internal Medicine and Gastroenterology, Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland
| | - Agnieszka Wierzbowska
- Department of Hematology, Copernicus Memorial Hospital in Lodz Comprehensive Cancer Center and Traumatology, Lodz, Poland.,Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Wojciech Fendler
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland.,Department of Radiation Oncology, Dana‑Farber Cancer Institute, Boston, MA, USA
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8
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Shimazu Y, Kanda J, Kaneko H, Imada K, Yamamura R, Kosugi S, Shimura Y, Ito T, Fuchida SI, Uchiyama H, Fukushima K, Yoshihara S, Hanamoto H, Tanaka H, Uoshima N, Ohta K, Yagi H, Shibayama H, Onda Y, Tanaka Y, Adachi Y, Matsuda M, Iida M, Miyoshi T, Matsui T, Takahashi R, Takakuwa T, Hino M, Hosen N, Nomura S, Shimazaki C, Matsumura I, Takaori-Kondo A, Kuroda J. Monocyte or white blood cell counts and β 2 microglobulin predict the durable efficacy of daratumumab with lenalidomide. Ther Adv Hematol 2022; 13:20406207221142487. [PMID: 36530751 PMCID: PMC9751172 DOI: 10.1177/20406207221142487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/14/2022] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Daratumumab is one of the most widely used treatments for relapsed/refractory multiple myeloma (MM) patients. However, not all patients achieve a lasting therapeutic response with daratumumab. OBJECTIVES We hypothesized that a durable response to daratumumab could be predicted by the balance between the MM tumor burden and host immune status. DESIGN We conducted a retrospective study using the real-world data in the Kansai Myeloma Forum (KMF) database. METHODS We retrospectively analyzed 324 relapsed/refractory MM patients who were treated with daratumumab in the KMF database. RESULTS In this study, 196 patients were treated with daratumumab, lenalidomide, and dexamethasone (DLd) regimen and 128 patients were treated with daratumumab, bortezomib, and dexamethasone (DBd) regimen. The median age at treatment, number of prior treatment regimens and time-to-next-treatment (TTNT) were 68, 4 and 8.02 months, respectively. A multivariate analysis showed that the TTNT under the DLd regimen was longer with either higher monocyte counts (analysis 1), higher white blood cell (WBC) counts (analysis 2), lower β2 microglobulin (B2MG < 5.5 mg/L) or fewer prior regimens (<4). No parameters were correlated with TTNT under the DBd regimen. CONCLUSION We propose a simple scoring model to predict a durable effect of the DLd regimen by classifying patients into three categories based on either monocyte counts (0 points for ⩾200/μl; 1 point for <200/μl) or WBC counts (0 points for ⩾3500/μl; 1 point for <3500/μl) plus B2MG (0 points for <5.5 mg/L; 1 point for ⩾5.5 mg/L). Patients with a score of 0 showed significantly longer TTNT and significantly better survival compared to those with a score of 1 or 2 (both p < 0.001). To confirm this concept, our results will need to be validated in other cohorts.
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Affiliation(s)
- Yutaka Shimazu
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Hitomi Kaneko
- Department of Hematology, Japanese Red Cross Osaka Hospital, Osaka, Japan
| | - Kazunori Imada
- Department of Hematology, Japanese Red Cross Osaka Hospital, Osaka, Japan
| | - Ryosuke Yamamura
- Department of Hematology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Satoru Kosugi
- Department of Internal Medicine (Hematology), Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Yuji Shimura
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomoki Ito
- First Department of Internal Medicine, Kansai Medical University, Moriguchi, Japan
| | - Shin-ichi Fuchida
- Department of Hematology, Japan Community Health care Organization Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | - Hitoji Uchiyama
- Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Kentaro Fukushima
- Department of Hematology and Oncology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Satoshi Yoshihara
- Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hitoshi Hanamoto
- Department of Hematology, Kindai University Nara Hospital, Ikoma, Japan
| | - Hirokazu Tanaka
- Department of Hematology and Rheumatology, Faculty of Medicine, Kindai University, Osakasayama, Japan
| | - Nobuhiko Uoshima
- Department of Hematology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | | | - Hideo Yagi
- Department of Hematology and Oncology, Nara Prefecture General Medical Center, Nara, Japan
| | - Hirohiko Shibayama
- Department of Hematology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yoshiyuki Onda
- Department of Hematology, Japanese Red Cross Takatsuki Hospital, Takatsuki, Japan
| | - Yasuhiro Tanaka
- Department of Hematology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yoko Adachi
- Department of Internal Medicine, Japan Community Health care Organization Kobe Central Hospital, Kobe, Japan
| | | | - Masato Iida
- Department of Internal Medicine, Kawasaki Hospital, Kaizuka, Japan
| | - Takashi Miyoshi
- Department of Hematology, Uji Tokushukai Hospital, Uji, Japan
| | - Toshimitsu Matsui
- Department of Hematology, Nishiwaki Municipal Hospital, Nishiwaki, Japan
| | - Ryoichi Takahashi
- Department of Hematology, Omihachiman Community Medical Center, Omihachiman, Japan
| | - Teruhito Takakuwa
- Department of Hematology, Graduate School of Medicine, Osaka City University, Suita, Japan
| | - Masayuki Hino
- Department of Hematology, Graduate School of Medicine, Osaka City University, Suita, Japan
| | - Naoki Hosen
- Department of Hematology and Oncology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shosaku Nomura
- First Department of Internal Medicine, Kansai Medical University, Moriguchi, Japan
| | - Chihiro Shimazaki
- Department of Hematology, Japan Community Health care Organization Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | - Itaru Matsumura
- Department of Hematology and Rheumatology, Faculty of Medicine, Kindai University, Osakasayama, Japan
| | - Akifumi Takaori-Kondo
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Junya Kuroda
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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9
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Zhang L, Chen S, Wang W, Wang Y, Liang Y. A prognostic model for patients with primary extramedullary multiple myeloma. Front Cell Dev Biol 2022; 10:1021587. [PMID: 36506092 PMCID: PMC9732373 DOI: 10.3389/fcell.2022.1021587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
Background: Extramedullary disease is a manifestation of multiple myeloma, the prognosis of which remains poor even in the era of novel drugs. Therefore, we aimed to develop a predictive model for patients with primary extramedullary multiple myeloma (EMM). Methods: Clinical and laboratory data of patients diagnosed with primary EMM between July 2007 and July 2021 were collected and analyzed. Univariate and least absolute shrinkage and selection operation Cox regression analyses (LASSO) were used to select prognostic factors for overall survival (OS) to establish a nomogram prognostic model. The performance of the model was evaluated using concordance index which was internally validated by bootstraps with 1,000 resample, area under the curve (AUCs), and calibration curves. Results: 217 patients were included in this retrospective study. Patients with EMM had a higher rate of belonging to the male sex, age >50 years, advanced Durie-Salmon stage III, hypercalcemia, and low hemoglobin level. Compared with patients with bone-related extramedullary disease, those with extraosseous-related extramedullary disease had a higher frequency of advanced Durie-Salmon stage III, lower rate of hypercalcemia, and elevated prothrombin time. The OS and progression-free survival (PFS) of patients with bone-related extramedullary disease were significantly higher than those of patients with extraosseous-related extramedullary disease. After the univariate and LASSO analyses, six prognostic factors, including performance status, number of extramedullary involved sites, β2-microglobulin, lactate dehydrogenase, monocyte-lymphocyte ratio, and prothrombin time, were integrated to establish a nomogram. The model showed robust discrimination with a concordance index (C-index) of 0.775 (95% confidence interval [CI], 0.713-0.836), internally validated with the corrected C-index of 0.756, and excellent performance in time-dependent AUCs compared with other staging systems. The AUCs for 1-, 3-, and 5-year OS were 0.814, 0.744, and 0.832, respectively. The calibration curves exhibited good consistency between the observed and nomogram-predicted OS. The 5-year OS of patients in the high-risk group (23.3%; 95% CI, 13.9%-39.3%) was much worse than that in the low-risk group (73.0%; 95% CI, 62.5%-85.4%; p < 0.001). Conclusion: The nomogram predictive model based on six clinical variables showed good prognostic performance and could better predict individual survival in patients with EMM.
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Affiliation(s)
- Limei Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Shuzhao Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Weida Wang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Yun Wang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, China,*Correspondence: Yun Wang, ; Yang Liang,
| | - Yang Liang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, China,*Correspondence: Yun Wang, ; Yang Liang,
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10
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Xu ZY, Yao XC, Shi XJ, Du XR. Significance of preoperative peripheral blood neutrophil-lymphocyte ratio in predicting postoperative survival in patients with multiple myeloma bone disease. World J Clin Cases 2022; 10:4380-4394. [PMID: 35663088 PMCID: PMC9125285 DOI: 10.12998/wjcc.v10.i14.4380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 12/30/2021] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The neutrophil-lymphocyte ratio (NLR) is often used to predict a poor prognosis in patients with tumors. This study investigated the preoperative peripheral blood NLR in predicting postoperative survival (POS) in patients with multiple myeloma bone disease (MMBD).
AIM To evaluate whether NLR can be used to predict the prognosis of MMBD patients after surgery.
METHODS The clinical data of 82 MMBD patients who underwent surgical treatments in Beijing Chao-yang Hospital were collected. The NLR was obtained from the absolute number of neutrophils and lymphocytes, calculated by the number of neutrophils and divided by the number of lymphocytes. The peripheral blood lymphocyte percentage was used as the major marker to analyze the change in characteristics of the immune statuses of multiple myeloma patients.
RESULTS The NLR cut-off values of NLR ≥ 3 patients and NLR ≥ 4 patients were significantly correlated with POS. The 3- and 5-year cumulative survival rates of the high NLR group (NLR ≥ 3 patients) were 19.1% and 0.0%, respectively, which were lower than those of the low NLR group (NLR < 3 patients) (67.2% and 48.3%) (P = 0.000). In the high NLR group, POS (14.86 ± 14.28) was significantly shorter than that in the low NLR group (32.68 ± 21.76). Univariate analysis showed that the lymphocyte percentage 1 wk after the operation (19.33 ± 9.08) was significantly lower than that before the operation (25.72 ± 11.02). Survival analysis showed that postoperative chemotherapy, preoperative performance status and preoperative peripheral blood NLR ≥ 3 were independent risk factors for POS.
CONCLUSION The preoperative peripheral blood NLR can predict POS in MMBD patients. MMBD patients with a high preoperative NLR (NLR ≥ 3) showed poor prognosis.
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Affiliation(s)
- Zi-Yu Xu
- Department of Orthopedics, Beijing Chao-Yang Hospital, Beijing 100020, China
| | - Xing-Chen Yao
- Department of Orthopedics, Beijing Chao-Yang Hospital, Beijing 100020, China
| | - Xiang-Jun Shi
- Department of Hematology, Beijing Chao-Yang Hospital, Beijing 100020, China
| | - Xin-Ru Du
- Department of Orthopedics, Beijing Chao-Yang Hospital, Beijing 100020, China
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11
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Kim SY, Park SS, Lim JY, Lee JY, Yoon JH, Lee SE, Eom KS, Kim HJ, Min CK. Prognostic Role of the Ratio of Natural Killer Cells to Regulatory T cells in Patients with Multiple Myeloma Treated with Lenalidomide and Dexamethasone. Exp Hematol 2022; 110:60-68. [DOI: 10.1016/j.exphem.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/12/2022] [Accepted: 03/28/2022] [Indexed: 11/30/2022]
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12
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Giri S, Dahal S, Bal S, Godby KN, Richman J, Olszewski AJ, Williams GR, Brown C, Buford TW, Costa LJ, Bhatia S. Pre-treatment neutrophil to lymphocyte ratio as a biomarker of frailty and predictor of survival among older adults with multiple myeloma. J Geriatr Oncol 2021; 13:486-492. [PMID: 34924305 DOI: 10.1016/j.jgo.2021.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 11/16/2021] [Accepted: 12/06/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Neutrophil to Lymphocyte Ratio (NLR) combines a marker of inflammation and reduced cell turnover to reflect age related alterations in the immune system. Whether NLR can serve as a biomarker of frailty and predict survival among older adults with Multiple Myeloma (MM) is unknown. MATERIALS AND METHODS We used an electronic health record-derived database to identify older adults (age ≥ 60y) with incident MM diagnosed between 1/2011 and 2/2020, with known pre-treatment absolute neutrophil and lymphocyte count up to 90 days before the start of therapy. The calculated NLR values were stratified into quartiles (Q1-Q4). We constructed a previously validated, simplified frailty index combining age, comorbidity and ECOG performance status. We measured the association between NLR quartiles and this frailty index using a logistic regression, adjusted for age, sex and race/ethnicity. We used Kaplan Meier methods and multivariable Cox regression to assess the impact of NLR on overall survival adjusting for potential confounders. RESULTS We identified 1729 older adults with newly diagnosed MM, at a median age of 73y (IQR: 67-78y). The median NLR was 2.13 (IQR: 1.44 to 3.31). Of the 1135 evaluable patients, 55% met criteria for frailty. Multivariable analysis revealed a 2.1-fold higher odds of frailty (95%CI = 1.42-3.10, p < 0.001) for patients in the NLR Q4 group vs. NLR Q1 group. In a multivariable analysis, adjusting for age, sex, race/ethnicity, M-protein type, stage, high risk cytogenetics, baseline creatinine, LDH and type of first line therapy, patients in NLR Q4 group had a 1.51 times increased hazards of death (95%CI = 1.15-1.98, p 0.002) when compared to those in NLR Q1 group. CONCLUSION NLR, a readily available laboratory biomarker, is associated with frailty measured using a simplified frailty index as well as inferior overall survival among older adults with MM. Future studies should explore its value as a screening tool to identify frail older adults with MM.
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Affiliation(s)
- Smith Giri
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, United States; Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Sumit Dahal
- Department of Hospital Medicine, St. Joseph Hospital, Bangor, ME, United States
| | - Susan Bal
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kelly N Godby
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Joshua Richman
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Adam J Olszewski
- Division of Hematology-Oncology, Lifespan Cancer Institute, Providence, RI, United States
| | - Grant R Williams
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, United States; Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Cynthia Brown
- Division of Gerontology, Geriatrics & Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Thomas W Buford
- Division of Gerontology, Geriatrics & Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Luciano J Costa
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Smita Bhatia
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, United States
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13
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Zhaoyun L, Rong F. Predictive Role of Immune Profiling for Survival of Multiple Myeloma Patients. Front Immunol 2021; 12:663748. [PMID: 34290698 PMCID: PMC8287504 DOI: 10.3389/fimmu.2021.663748] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/23/2021] [Indexed: 01/10/2023] Open
Abstract
Despite new efficacy drugs and cell therapy have been used for multiple myeloma (MM) patients, some patients will relapse over time. We wonder the immune system play a vital role as well as MM cell during the development of disease. It is clear that the characteristic of myeloma cell is associated with the survival of MM patients. However, the link between the immune profiling and the prognosis of the disease is still not entirely clear. As more study focus on the role of immunity on multiple myeloma pathogenesis. There are plenty of study about the predictive role of immunity on the survival of multiple myeloma patients. Up to mow, the majority reviews published have focused on the immunotherapy and immune pathogenesis. It is indispensable to overlook the predictive role of immunity on multiple myeloma patients. Here, we give a review of vital previous works and recent progress related to the predictive role of immune profiling on multiple myeloma, such as absolute lymphocyte count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocytes and cytokines.
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Affiliation(s)
- Liu Zhaoyun
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Fu Rong
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
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14
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Di Raimondo C, Caposiena Caro RD, Spallone D, Silvaggio D, Lombardo P, Del Duca E, Campione E, Spallone G, Bianchi L. Baseline neutrophil/lymphocyte ratio (NLR) and red blood cell distribution width (RDW) correlate with advanced stages in cutaneous squamous cell carcinoma. Int J Dermatol 2021; 61:175-179. [PMID: 34212366 DOI: 10.1111/ijd.15755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 05/25/2021] [Accepted: 06/10/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The neutrophil/lymphocyte ratio (NLR) and red blood cell distribution width (RDW) at diagnosis have been shown to correlate with advanced disease and to be prognostic factors in many tumors. However, their role as a prognostic factor for cutaneous squamous cell carcinoma (cSCC) has not yet been studied. OBJECTIVE Therefore, the aim of our study was to evaluate the correlation of NLR and RDW with stages of disease in patients with cSCC in order to define whether or not higher values of these two markers correlate with a more aggressive disease. METHODS We retrospectively analyzed the NLR and RDW in a total of 51 newly diagnosed cSCC patients. NLR and RDW were calculated using data obtained from the complete blood count (CBC). RESULTS Median NLR among patients with the non-advanced disease (in situ and stage I) was 2.2, whereas median NLR for patients with advanced disease was 4.87. Median RDW among patients with early stage disease was 13.7%, while median RDW in patients with advanced disease was 15.81%. Statistical analysis showed positive associations of advanced cSCC stages with NLR or RDW higher than 3.07 or 14.5%, respectively. CONCLUSIONS Therefore, our analysis demonstrated how both NLR and RDW represent cheap and easily available factors that could be used as markers for advanced cSCC. They could help to identify patients with advanced stages disease that requires a strict follow-up.
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Affiliation(s)
| | | | - Diana Spallone
- Department of Plastic Surgery, San Giovanni Hospital, Rome, Italy
| | | | - Paolo Lombardo
- Department of Dermatology, University of Roma Tor Vergata, Rome, Italy
| | - Ester Del Duca
- Department of Dermatology, University of Roma Tor Vergata, Rome, Italy
| | - Elena Campione
- Department of Dermatology, University of Roma Tor Vergata, Rome, Italy
| | - Giulia Spallone
- Department of Dermatology, University of Roma Tor Vergata, Rome, Italy
| | - Luca Bianchi
- Department of Dermatology, University of Roma Tor Vergata, Rome, Italy
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15
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Leone P, Solimando AG, Malerba E, Fasano R, Buonavoglia A, Pappagallo F, De Re V, Argentiero A, Silvestris N, Vacca A, Racanelli V. Actors on the Scene: Immune Cells in the Myeloma Niche. Front Oncol 2020; 10:599098. [PMID: 33194767 PMCID: PMC7658648 DOI: 10.3389/fonc.2020.599098] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/05/2020] [Indexed: 12/11/2022] Open
Abstract
Two mechanisms are involved in the immune escape of cancer cells: the immunoediting of tumor cells and the suppression of the immune system. Both processes have been revealed in multiple myeloma (MM). Complex interactions between tumor plasma cells and the bone marrow (BM) microenvironment contribute to generate an immunosuppressive milieu characterized by high concentration of immunosuppressive factors, loss of effective antigen presentation, effector cell dysfunction, and expansion of immunosuppressive cell populations, such as myeloid-derived suppressor cells, regulatory T cells and T cells expressing checkpoint molecules such as programmed cell death 1. Considering the great immunosuppressive impact of BM myeloma microenvironment, many strategies to overcome it and restore myeloma immunosurveillance have been elaborated. The most successful ones are combined approaches such as checkpoint inhibitors in combination with immunomodulatory drugs, anti-monoclonal antibodies, and proteasome inhibitors as well as chimeric antigen receptor (CAR) T cell therapy. How best to combine anti-MM therapies and what is the optimal timing to treat the patient are important questions to be addressed in future trials. Moreover, intratumor MM heterogeneity suggests the crucial importance of tailored therapies to identify patients who might benefit the most from immunotherapy, reaching deeper and more durable responses.
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Affiliation(s)
- Patrizia Leone
- Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | - Antonio Giovanni Solimando
- Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
- Department of Medical Oncology, IRCCS Istituto Tumori “Giovanni Paolo II” of Bari, Bari, Italy
| | - Eleonora Malerba
- Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | - Rossella Fasano
- Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | - Alessio Buonavoglia
- Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | - Fabrizio Pappagallo
- Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | - Valli De Re
- Bio-Proteomics Facility, Department of Translational Research, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Antonella Argentiero
- Department of Medical Oncology, IRCCS Istituto Tumori “Giovanni Paolo II” of Bari, Bari, Italy
| | - Nicola Silvestris
- Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
- Department of Medical Oncology, IRCCS Istituto Tumori “Giovanni Paolo II” of Bari, Bari, Italy
| | - Angelo Vacca
- Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | - Vito Racanelli
- Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
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16
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Pang Y, Shao H, Yang Z, Fan L, Liu W, Shi J, Wang Y, Han Y, Yang L. The (Neutrophils + Monocyte)/Lymphocyte Ratio Is an Independent Prognostic Factor for Progression-Free Survival in Newly Diagnosed Multiple Myeloma Patients Treated With BCD Regimen. Front Oncol 2020; 10:1617. [PMID: 32984029 PMCID: PMC7492571 DOI: 10.3389/fonc.2020.01617] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 07/27/2020] [Indexed: 12/17/2022] Open
Abstract
Objective Bortezomib is one of the important drugs that have made breakthrough progress in multiple myeloma (MM) in the past 10 years. However, the heterogeneity of its efficacy makes it difficult to predict the risk of disease progression. The purpose of this study is to determine the prognostic significance of the (neutrophils + monocytes)/lymphocytes ratio (NMLR) in newly diagnosed MM patients who received BCD regimen therapy in terms of progression-free survival (PFS). Methods A total of 150 patients who fulfilled the International Myeloma Working Group (IMWG) criteria were enrolled in the study retrospectively. The prognostic value of NMLR was evaluated by 150 patients with MM who were treated with BCD (bortezomib + cyclophosphamide + dexamethasone) regimen therapy. NMLR was calculated by the ratio of (neutrophils + monocyte) to lymphocytes. According to receiver operating characteristic curves, the cutoff value was 1.90. The patients were divided into high NMLR group (H-NMLR, NMLR ≥1.90) and low NMLR group (L-NMLR, NMLR <1.90). The clinical characteristics, treatment responses and PFS of the two groups were analyzed. Results The median age of the patients was 61 years. Fifty-five (36.67%) patients showed lower NMLR at initial diagnosis. Although NMLR was unable to discriminate prognosis in ISS stage I/II patients, interestingly, the addition of NMLR to the ISS further defined prognosis particularly in stage III. Low-NMLR group who achieved early immune reconstruction significantly higher than that of the high-NMLR group (P < 0.001). NMLR value was 1.98 ± 1.02 for the patients who achieved early immune reconstruction, which was 3.26 ± 2.52 for the patients without immune reconstruction (P < 0.05). Compared with the H-NMLR group, the levels of β2-microglobulin, serum creatinine and calcium were lower, and the very good partial response or better (≥VGPR) ratio was higher in L-NMLR group. The L-NMLR group experienced a superior median PFS compared with the H-NMLR group (24.0 versus 15.5 months; P < 0.001). In addition, several other prognostic factors of PFS were estimated, including the high-risk cytogenetics, β2-microglobulin and the depth of treatment response 3 months after treatment with BCD regimen. Moreover, NMLR was an independent predictor of PFS including non-high risk cytogenetics (0.587; P = 0.031). Conclusion In patients with newly diagnosed MM undergoing BCD regimen, the NMLR <1.90 was an independent prognostic factor for PFS as well as early immune reconstruction and lower disease burden.
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Affiliation(s)
- Yanbin Pang
- Department of Hematology, Affiliated Hospital of Hebei University, Baoding, China.,Department of Hematology-Oncology, General Hospital of Shenzhen University, Shenzhen, China
| | - Hong Shao
- Department of Hematology, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ziheng Yang
- Medical College, Medical Department of Hebei University, Baoding, China
| | - Lixia Fan
- Department of Hematology, Affiliated Hospital of Hebei University, Baoding, China
| | - Wenwen Liu
- Central Laboratory, Affiliated Hospital of Hebei University, Baoding, China
| | - Jianhong Shi
- Central Laboratory, Affiliated Hospital of Hebei University, Baoding, China
| | - Yuqing Wang
- Department of Cell Morphology, Affiliated Hospital of Hebei University, Baoding, China
| | - Ying Han
- Department of Hematology, Affiliated Hospital of Hebei University, Baoding, China
| | - Lin Yang
- Department of Hematology, Second Hospital of Hebei Medical University, Shijiazhuang, China
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17
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Prognostic value of pretreatment neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in multiple myeloma patients treated with thalidomide-based regimen. Ann Hematol 2020; 99:2881-2891. [PMID: 32458064 PMCID: PMC7683474 DOI: 10.1007/s00277-020-04092-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 05/17/2020] [Indexed: 12/18/2022]
Abstract
Neutrophils to lymphocytes ratio (NLR) and platelets to lymphocytes ratio (PLR) are considered as laboratory markers of inflammation. They can be potentially useful in predicting the course of multiple neoplasms including selected hematological cancers. The aim of the study was to assess the value of NLR and PLR in predicting the effects of therapy and prognosis in multiple myeloma patients treated with thalidomide-based regimen. The study group consisted of 100 patients treated with the first line CTD (cyclophosphamide, thalidomide, and dexamethasone) chemotherapy. The NLR and PLR were calculated before treatment. High NLR was observed in patients with higher stage of the disease, with poor performance status, hypercalcemia, and high CRP. High PLR was associated with low BMI and high CRP. In patients with high NLR, significantly shorter PFS was observed (17 vs. 26 months, p = 0.0405). In addition, high values of NLR and PLR were associated with significantly shorter OS (38 vs. 79 months, p = 0.0010; 40 vs. 78 months, p = 0.0058). Summarizing, NLR and PLR have a significant independent prognostic value for multiple myeloma patients. Furthermore, the NLR can be a predictive marker for the outcome of thalidomide-based chemotherapy.
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18
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Solmaz S, Uzun O, Acar C, Sevindik OG, Piskin O, Ozsan HG, Demirkan F, Undar B, Alacacioglu A, Ozcan MA, Alacacioglu I. Is the platelet-to-lymphocyte ratio a new prognostic marker in multiple myeloma? J Lab Physicians 2020; 10:363-369. [PMID: 30498304 PMCID: PMC6210833 DOI: 10.4103/jlp.jlp_36_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Recent reports showed neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), as a predictor of progression-free survival (PFS) and overall survival (OS) in various malignancies. MATERIALS AND METHODS We retrospectively examined the PLR, NLR, and MLR in a cohort of 186 newly diagnosed multiple myeloma (MM) patients. This study investigated the prognostic relevance of NLR, PLR, and MLR in MM patients. NLR, PLR, and MLR were calculated from whole blood counts before therapy. The Kaplan-Meier curves and multivariate Cox models were used for the evaluation of survival. RESULTS Applying cutoff of 1.9 (NLR), 120.00 (PLR), and 0.27 (MLR), decreased PLR showed a negative impact on the outcome. Decreased PLR is an independent predictor for PFS and OS. There were no significant differences in median survival between the high and low NLR (P = 0.80) and MLR (P = 0.87) groups. CONCLUSIONS In this study, thrombocytopenia and low PLR are associated with poor survival in MM patients does this P value apply to thrombocytopenia or low PLR and may serve as the cost-effective prognostic biomarker.
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Affiliation(s)
- Serife Solmaz
- Department of Hematology, Bozyaka Education and Research Hospital, Batman, Turkey
| | - Ozcan Uzun
- Department of Internal Medicine, Batman Education and Research Hospital, Batman, Turkey
| | - Celal Acar
- Department of Hematology, Bozyaka Education and Research Hospital, Batman, Turkey
| | - Omur Gokmen Sevindik
- Department of Hematology, Faculty of Medicine, Medipol Universıty, Istanbul, Turkey
| | - Ozden Piskin
- Department of Hematology, Faculty of Medicine, Dokuz Eylul Universıty, Izmir, Turkey
| | - Hayri Guner Ozsan
- Department of Hematology, Faculty of Medicine, Dokuz Eylul Universıty, Izmir, Turkey
| | - Fatih Demirkan
- Department of Hematology, Faculty of Medicine, Dokuz Eylul Universıty, Izmir, Turkey
| | - Bulent Undar
- Department of Hematology, Faculty of Medicine, Dokuz Eylul Universıty, Izmir, Turkey
| | | | - Mehmet Ali Ozcan
- Department of Hematology, Faculty of Medicine, Dokuz Eylul Universıty, Izmir, Turkey
| | - Inci Alacacioglu
- Department of Hematology, Faculty of Medicine, Dokuz Eylul Universıty, Izmir, Turkey
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Romano A, Parrinello NL, Simeon V, Puglisi F, La Cava P, Bellofiore C, Giallongo C, Camiolo G, D'Auria F, Grieco V, Larocca F, Barbato A, Cambria D, La Spina E, Tibullo D, Palumbo GA, Conticello C, Musto P, Di Raimondo F. High-density neutrophils in MGUS and multiple myeloma are dysfunctional and immune-suppressive due to increased STAT3 downstream signaling. Sci Rep 2020; 10:1983. [PMID: 32029833 PMCID: PMC7005058 DOI: 10.1038/s41598-020-58859-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 01/06/2020] [Indexed: 02/07/2023] Open
Abstract
To understand neutrophil impairment in the progression from MGUS through active MM, we investigated the function of mature, high-density neutrophils (HDNs), isolated from peripheral blood. In 7 MM, 3 MGUS and 3 healthy subjects by gene expression profile, we identified a total of 551 upregulated and 343 downregulated genes in MM-HDN, involved in chemokine signaling pathway and FC-gamma receptor mediated phagocytosis conveying in the activation of STAT proteins. In a series of 60 newly diagnosed MM and 30 MGUS patients, by flow-cytometry we found that HDN from MM, and to a lesser extend MGUS, had an up-regulation of the inducible FcγRI (also known as CD64) and a down-regulation of the constitutive FcγRIIIa (also known as CD16) together with a reduced phagocytic activity and oxidative burst, associated to increased immune-suppression that could be reverted by arginase inhibitors in co-culture with lymphocytes. In 43 consecutive newly-diagnosed MM patients, who received first-line treatment based on bortezomib, thalidomide and dexamethasone, high CD64 could identify at diagnosis patients with inferior median overall survival (39.5 versus 86.7 months, p = 0.04). Thus, HDNs are significantly different among healthy, MGUS and MM subjects. In both MGUS and MM neutrophils may play a role in supporting both the increased susceptibility to infection and the immunological dysfunction that leads to tumor progression.
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Affiliation(s)
- A Romano
- Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
- Division of Hematology, Azienda Ospedaliera Policlinico e Vittorio Emanuele di Catania, Catania, Italy
| | - N L Parrinello
- Division of Hematology, Azienda Ospedaliera Policlinico e Vittorio Emanuele di Catania, Catania, Italy
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", University of Catania, Catania, Italy
| | - V Simeon
- Laboratory of Pre-Clinical Research and Advanced Diagnostics, IRCCS-CROB, Rionero in Vulture (Pz), Potenza, Italy
- Department of Mental Health and Preventive Medicine, Medical Statistics Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - F Puglisi
- Division of Hematology, Azienda Ospedaliera Policlinico e Vittorio Emanuele di Catania, Catania, Italy
| | - P La Cava
- Division of Hematology, Azienda Ospedaliera Policlinico e Vittorio Emanuele di Catania, Catania, Italy
| | - C Bellofiore
- Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
- Division of Hematology, Azienda Ospedaliera Policlinico e Vittorio Emanuele di Catania, Catania, Italy
| | - C Giallongo
- Division of Hematology, Azienda Ospedaliera Policlinico e Vittorio Emanuele di Catania, Catania, Italy
| | - G Camiolo
- Division of Hematology, Azienda Ospedaliera Policlinico e Vittorio Emanuele di Catania, Catania, Italy
| | - F D'Auria
- Laboratory of Pre-Clinical Research and Advanced Diagnostics, IRCCS-CROB, Rionero in Vulture (Pz), Potenza, Italy
| | - V Grieco
- Laboratory of Pre-Clinical Research and Advanced Diagnostics, IRCCS-CROB, Rionero in Vulture (Pz), Potenza, Italy
| | - F Larocca
- Laboratory of Pre-Clinical Research and Advanced Diagnostics, IRCCS-CROB, Rionero in Vulture (Pz), Potenza, Italy
| | - A Barbato
- Division of Hematology, Azienda Ospedaliera Policlinico e Vittorio Emanuele di Catania, Catania, Italy
| | - D Cambria
- Division of Hematology, Azienda Ospedaliera Policlinico e Vittorio Emanuele di Catania, Catania, Italy
| | - E La Spina
- Biometec, Dipartimento di Scienze Biomediche e Biotecnologiche, University of Catania, Catania, Italy
| | - D Tibullo
- Biometec, Dipartimento di Scienze Biomediche e Biotecnologiche, University of Catania, Catania, Italy
| | - G A Palumbo
- Division of Hematology, Azienda Ospedaliera Policlinico e Vittorio Emanuele di Catania, Catania, Italy
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", University of Catania, Catania, Italy
| | - C Conticello
- Division of Hematology, Azienda Ospedaliera Policlinico e Vittorio Emanuele di Catania, Catania, Italy
| | - P Musto
- Laboratory of Pre-Clinical Research and Advanced Diagnostics, IRCCS-CROB, Rionero in Vulture (Pz), Potenza, Italy
- Chair and Unit of Hematology and Stem Cell Transplantation, Aldo Moro University, Bari, Italy
| | - F Di Raimondo
- Department of Surgery and Medical Specialties, University of Catania, Catania, Italy.
- Division of Hematology, Azienda Ospedaliera Policlinico e Vittorio Emanuele di Catania, Catania, Italy.
- Department of Mental Health and Preventive Medicine, Medical Statistics Unit, University of Campania "Luigi Vanvitelli", Naples, Italy.
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Body Mass Index and Modified Glasgow Prognostic Score Are Useful Predictors of Surgical Site Infection After Spinal Instrumentation Surgery: A Consecutive Series. Spine (Phila Pa 1976) 2020; 45:E148-E154. [PMID: 31513100 DOI: 10.1097/brs.0000000000003226] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Retrospective observational study. OBJECTIVE To analyze a large consecutive cohort of patients who had undergone spinal instrumentation surgery, to characterize a patient population with surgical site infections (SSI), and to identify preoperative risk factors associated with SSI. SUMMARY OF BACKGROUND DATA Malnutrition is a risk factor for SSI in many health conditions; however, the evidence connecting preoperative malnutrition with SSI in spinal instrumentation surgery is limited because of the small number of retrospective studies. While the modified Glasgow prognostic score (mGPS), C-Reactive protein (CRP)-albumin ratio (CAR), controlling nutritional status index (CONUT), prognostic nutritional index (PNI), platelet-lymphocyte ratio (PLR), and neutrophil-lymphocyte ratio (NLR) are established methods for evaluating nutritious status, little has been reported on the predictive value of these indicators with respect to postoperative spinal infection. METHODS We retrospectively investigated 384 patients who underwent spinal instrumentation surgery. We evaluated the significance of risk factors, including mGPS, CAR, CONUT, PNI, PLR, and NLR. We then performed stepwise logistic regression analysis to analyze the concurrent effects of various factors on the prevalence of SSI. RESULTS Of the 384 patients analyzed, 14 were diagnosed with SSIs. Univariate analysis showed that preoperative BMI, lymphocyte count, albumin, erythrocyte sedimentation rate, CRP, CONUT, mGPS, CAR, and PNI were risk factors for SSI. Stepwise logistic regression analysis revealed that higher mGPS and lower BMI before surgery were independent risk factors for SSI. A receiver operating characteristic curve showed that the cut-off values of mGPS and BMI were 1 and 20.39, respectively. CONCLUSION The risk factors for SSI after spinal instrumentation surgery were mGPS more than or equal to 1 and BMI less than or equal to 20.39 kg/m. These findings could help to identify patients at higher risk of SSI after spinal instrumentation surgery. LEVEL OF EVIDENCE 4.
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Combined immune score of lymphocyte to monocyte ratio and immunoglobulin levels predicts treatment-free survival of multiple myeloma patients after autologous stem cell transplant. Bone Marrow Transplant 2019; 55:199-206. [PMID: 31527821 DOI: 10.1038/s41409-019-0681-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 07/04/2019] [Accepted: 07/13/2019] [Indexed: 12/22/2022]
Abstract
Outcomes after ASCT are highly variable making it difficult to predict risk of disease progression. We analyzed the impact of clinically available immune-related biomarkers on treatment-free survival (TFS) in 130 patients receiving Mel200 and ASCT. Absolute lymphocyte count (ALC), monocyte count (AMC), neutrophil count (ANC), and immunoglobulin (Ig) levels were collected on day -2 and 90 of ASCT. The lymphocyte-monocyte (LMR) and neutrophil-lymphocyte ratios (NLR) were then derived. At Day +90, we found that low ALC (18 versus 23 months, p = 0.04) or AMC (13 versus 25 months, p = 0.02) predicted for worse TFS. A low LMR predicted for worse TFS (16 versus 52 months, p = 0.004). Patients with two or three suppressed Ig levels had worse TFS (17 versus 51 months, p = 0.04). Median TFS for poor (low LMR and 2-3 suppressed Ig), intermediate, and good (high LMR and 0-1 suppressed Ig) risk groups was 7.5 versus 27 versus 79 months, respectively (p = 0.0004). In a multivariate analysis, a low LMR and suppressed Ig levels were strong independent predictors of poor TFS. We propose an immune score combining these available tests to stratify patients at risk for early progression and identify those who may benefit from intensified post-ASCT consolidation or immunotherapy based approaches.
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Hu Y, Cheng Y, Xu X, Yang B, Mei F, Zhou Q, Yan L, Wang J, Wu X. Pretreatment neutrophil-to-lymphocyte ratio predicts prognosis in patients with diabetic macular edema treated with ranibizumab. BMC Ophthalmol 2019; 19:194. [PMID: 31455273 PMCID: PMC6712590 DOI: 10.1186/s12886-019-1200-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 08/15/2019] [Indexed: 12/04/2022] Open
Abstract
Background To investigate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in patients with diabetic macular edema (DME) treated monthly with ranibizumab. Methods We retrospectively analyzed the medical records of all patients who received intravitreal ranibizumab (IVR) treatment for DME at the First Affiliated Hospital of Nanchang University between December 2015 and December 2017. Clinicopathological parameters, including NLR, were evaluated to identify predictors of better outcomes of IVR monotherapy. Results Ninety-one treatment-naïve eyes treated with IVR for DME were retrospectively analyzed in this study. Baseline best-corrected visual acuity (BCVA), neutrophils, NLR, monocyte-to-lymphocyte ratio, and platelet-to-lymphocyte ratio were negatively correlated with the changes in BCVA at 24 weeks compared with the baseline, while baseline central retinal thickness and lymphocytes were positively correlated with the changes in BCVA at 24 weeks compared with the baseline. Multiple linear regression analysis revealed that NLR was independently associated with the mean change of BCVA between baseline and week 24. In addition, patients with NLR < 2.27 showed a better improvement in letter score than those with NLR > 2.27. Conclusion Pretreatment NLR is independently associated with the BCVA in DME patients treated with IVR, and higher pretreatment NLR may contribute to inferior BCVA outcomes.
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Affiliation(s)
- Yuxiang Hu
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, No. 17, Nanchang, 330006, China
| | - Yi Cheng
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, No. 17, Nanchang, 330006, China
| | - Xiaoxuan Xu
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, No. 17, Nanchang, 330006, China
| | - Bo Yang
- Department of Ophthalmology, Xinjiang People's Hospital, Urumqi, China
| | - Feng Mei
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, No. 17, Nanchang, 330006, China
| | - Qiong Zhou
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, No. 17, Nanchang, 330006, China
| | - Li Yan
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, No. 17, Nanchang, 330006, China
| | - Jun Wang
- Second Department of Respiratory Disease, Jiangxi Provincial People's Hospital, Nanchang, China
| | - Xiaorong Wu
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, No. 17, Nanchang, 330006, China.
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Plasticity of High-Density Neutrophils in Multiple Myeloma is Associated with Increased Autophagy Via STAT3. Int J Mol Sci 2019; 20:ijms20143548. [PMID: 32565533 PMCID: PMC6678548 DOI: 10.3390/ijms20143548] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/13/2019] [Accepted: 07/16/2019] [Indexed: 01/16/2023] Open
Abstract
In both monoclonal gammopathy of uncertain significance (MGUS) and multiple myeloma (MM) patients, immune functions are variably impaired, and there is a high risk of bacterial infections. Neutrophils are the most abundant circulating leukocytes and constitute the first line of host defense. Since little is known about the contribution of autophagy in the neutrophil function of MGUS and MM patients, we investigated the basal autophagy flux in freshly sorted neutrophils of patients and tested the plastic response of healthy neutrophils to soluble factors of MM. In freshly sorted high-density neutrophils obtained from patients with MGUS and MM or healthy subjects, we found a progressive autophagy trigger associated with soluble factors circulating in both peripheral blood and bone marrow, associated with increased IFNγ and pSTAT3S727. In normal high-density neutrophils, the formation of acidic vesicular organelles, a morphological characteristic of autophagy, could be induced after exposure for three hours with myeloma conditioned media or MM sera, an effect associated with increased phosphorylation of STAT3-pS727 and reverted by treatment with pan-JAK2 inhibitor ruxolitinib. Taken together, our data suggest that soluble factors in MM can trigger contemporary JAK2 signaling and autophagy in neutrophils, targetable with ruxolitinib.
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Hussain A, Almenfi HF, Almehdewi AM, Hamza MS, Bhat MS, Vijayashankar NP. Laboratory Features of Newly Diagnosed Multiple Myeloma Patients. Cureus 2019; 11:e4716. [PMID: 31355076 PMCID: PMC6650180 DOI: 10.7759/cureus.4716] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives: Multiple myeloma (MM) is a malignant disorder characterized by proliferation of a single clone of plasma cells derived from β-cells in the bone marrow. It is the second most common adult hematological malignancy, and it is the most common cancer with skeletal components as its primary site. The purpose of the retrospective study was to assess the hematological profile, different biochemical parameters, and the serum electrophoresis patterns of patients consistent with clinical symptoms of multiple myeloma. Materials and methods: A retrospective study of 99 patients diagnosed with multiple myeloma (MM) was carried out at the Hematology Department of Benghazi Medical Center (BMC) in Benghazi, Libya from January 2010 to March 2017. Information on the laboratory features was obtained at presentation (before treatment) and analyzed. Results: Of the 99 study detected cases of multiple myeloma at diagnosis, 14% were younger than 45 years and 35% were 70 years or older. The mean age was 61 years, of which 42 (42.4%) were males and 57 (57.6%) were females. Anemia was seen in roughly half of the diagnosed cases, most of which was normocytic normochromic anemia. High erythrocyte sedimentation rate (ESR) was seen in 65.3% of cases and increased neutrophil-to-lymphocyte ratio (NLR) was seen in 29.7%. Other abnormal serum levels with regard to the cases are as follows: hyperproteinemia in 30%, low albumin/globulin (A/G) ratio in 54.2%, hypercalcemia in 11.3%, serum creatinine level of >2.0 mg/dL in 27.2% cases, and increased β2-microglobulin in 67%. Serum protein electrophoresis revealed a localized band in 70.8% of patients. Monoclonal bands were seen in 44 cases (95.7%) and a bi-clonal pattern in two cases (4.3%), 78% of M-band showed migration to γ-region of electrophoretogram and 18% to β-region. Hypogammaglobulinemia was detected in 32.8% and hypergammaglobulinemia was detected in 49.2%. Of the hypergammaglobulinemia, 18.1% showed polyclonal gammaglobulinemia. Bence Jones protein was positive in 50% cases. IgG was the commonest type, followed by IgA then light chain. In 26.5% of cases, the only diagnosis was multiple myeloma. Light chain multiple myeloma patients had high α2 globulin concentration and normal A/G ratio. Apart from the diagnosis of multiple myeloma, a number of cases had varying diagnoses including the following: 4% non-secretory myeloma, 2% amyloidosis with nephrotic syndrome, 2% liver cirrhosis, and 18.2% renal failure. Most patients presented in stage III. Conclusions: The presence of anemia, high ESR, and low A/G ratio in elderly patients should alert the clinician to investigate along the lines of multiple myeloma. In this study, unfortunately, the laboratory investigations were insufficient for diagnosing this disease in most patients. Most patients were diagnosed at stage III. Absence of paraprotein in the blood does not exclude multiple myeloma. It was further observed that most of the patients presented with significant renal damage, which attributed to hyperuricemia, hypercalcemia, or high NLR. Multiple causes of renal failure occur in myeloma and are often present at the time of diagnosis.
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Affiliation(s)
- Azhar Hussain
- Medicine, Xavier University School of Medicine, Oranjestad, ABW
| | | | | | - Mohammed S Hamza
- Nutrition, Faculty of Public Health / Benghazi University, Benghazi, LBY
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Dolan RD, Laird BJ, Horgan PG, McMillan DC. The prognostic value of the systemic inflammatory response in randomised clinical trials in cancer: A systematic review. Crit Rev Oncol Hematol 2018; 132:130-137. [DOI: 10.1016/j.critrevonc.2018.09.016] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/10/2018] [Accepted: 09/29/2018] [Indexed: 12/18/2022] Open
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Pierre-Louis WS, Bath J, Mikkilineni S, Scott MC, Harlander-Locke M, Rasor Z, Smeds M. Neutrophil to Lymphocyte Ratio as a Predictor of Outcomes after Amputation. Ann Vasc Surg 2018; 54:84-91. [PMID: 30339899 DOI: 10.1016/j.avsg.2018.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 10/02/2018] [Accepted: 10/09/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR) has become a prognostic marker for proinflammatory states. It is associated with outcomes in many clinical processes including critical limb ischemia. We sought to identify predictors of amputation failure and mortality, in addition to the role of NLR in patients undergoing above-knee amputations (AKAs) or below-knee amputations (BKAs). METHODS All patients undergoing BKA or AKA between 2004 and 2014 at 3 institutions were identified and analyzed (n = 513). Patients were excluded if they did not have a complete blood count with differential within 7 days prior to their operations. Comparison groups were formed between patients requiring unplanned revision and those who did not, and additionally between survivors and nonsurvivors at 30 days postamputation. Patient demographics, intraoperative data, and postoperative courses were compared. A multinomial logistic regression model was created to further compare the groups. RESULTS Four hundred and ten patients were included for analysis, of which 142 (35%) required unplanned revision. Nearly 5% of patients (19/410) died within 30 days of the initial amputation. On univariate analysis, those requiring revision were more likely to be current smokers compared to former smokers (P = 0.004 and P = 0.021, respectively), have a lower ankle-brachial index (ABI) (P = 0.019), and have undergone a BKA (P < 0.001). Patients with congestive heart failure (CHF) were less likely to require a revision after an amputation (P = 0.007). Postoperative NLR was higher in patients requiring revision (9.9 vs. 7.0, P < 0.001) and both preoperative and postoperative NLRs were higher in those with 30-day mortality (21.0 vs. 7.0, P < 0.001; 19.4 vs. 7.5, P < 0.001). A multinomial logistic regression model identified CHF (P = 0.004), ABI (P = 0.041), and elevated body mass index (BMI, P = 0.045) as predictors of revision, while coronary artery disease (CAD, P = 0.031), CHF (P = 0.029), and postoperative NLR (P < 0.001) were predictive of 30-day mortality. CONCLUSIONS Postoperative elevated NLR, CAD, and CHF are predictors of 30-day mortality in patients undergoing major limb amputation, while CHF, elevated ABI, and high BMI are predictors of revision. This study suggests that NLR may have a role as a biomarker for poor outcomes in patients with underlying peripheral vascular disease and warrants further investigation.
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Affiliation(s)
| | - Jonathan Bath
- Division of Vascular Surgery, University of Missouri Hospitals & Clinics, Columbia, MO
| | | | - Michael C Scott
- University of Arkansas for Medical Sciences, Little Rock, AR
| | | | - Zachary Rasor
- Division of Podiatric Surgery, University of Cincinnati Medical Center, Cincinnati, OH
| | - Matthew Smeds
- Division of Vascular Surgery, St. Louis University, St. Louis, MO
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Zhou X, Wang J, Xia J, Cheng F, Mao J, Zhu J, Guo H. Evaluation of neutrophil-to-lymphocyte ratio in newly diagnosed patients receiving borte- zomib-based therapy for multiple myeloma. Cancer Biomark 2018; 22:43-48. [PMID: 29562497 DOI: 10.3233/cbm-170795] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR) at diagnosis has been identified as an independent prognostic marker in several malignancies. Recently, a few studies have reported that an elevated pretreatment NLR is associated with poor survival among multiple myeloma (MM) patients. However, the role of NLR at diagnosis in patients with MM treated with regimens containing bortezomib has been less explored. OBJECTIVE We aimed to investigate the relationships between NLR and overall survival (OS) in newly diagnosed patients receiving bortezomib-based therapy for MM. METHODS A total of 76 newly diagnosed patients with MM treated with bortezomib-based regimes were analyzed retrospectively. NLR was calculated from whole blood counts prior to therapy and subsequently correlated with OS. RESULTS Complete remission (CR) was seen in 39.2% of patients with NLR < 2.95 compared to 20% in the group with NLR ⩾ 2.95 (P= 0.094). NLR was lower in CR patients in comparison to Non-CR subjects (P= 0.044). Patients with a NLR ⩾ 2.95 experienced inferior median survival compared to those with NLR < 2.95 (4-year OS rates were 30.9% and 64.8%, respectively, P= 0.029). In multivariate analysis, only elevated LDH and IgA MM were factors predicting inferior OS. CONCLUSIONS Elevated NLR was associated with poor OS in MM patients receiving induction therapy with bortezomib-based regimens, but it was not an independent prognostic factor in this patient cohort.
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Zeng Q, Liu Z, Li Q, Liu T. Prognostic value of neutrophil to lymphocyte ratio and clinicopathological characteristics for multiple myeloma: A meta-analysis. Medicine (Baltimore) 2018; 97:e12678. [PMID: 30313061 PMCID: PMC6203562 DOI: 10.1097/md.0000000000012678] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Neutrophil to lymphocyte ratio (NLR) was reported to be an effective parameter in carcinoma prognosis. Many studies were already performed to investigate the prognostic value of NLR in patients with multiple myeloma (MM). The results, however, were still debatable. METHODS Databases of Pubmed, Cochrane library and Embase were examined. Hazard ratio (HR) with 95% confidence interval (CI) was used to assess the results. In addition, odds ratios (ORs) with 95% CIs were used to evaluate the association of NLR with clinicopathological factors. Meta-regression, sensitivity analysis, and subgroup analysis were also performed. RESULTS The results showed poor OS (HR: 1.73, 95% CI: 1.23-2.44; P = .002) and progression-free survival (PFS) (HR: 1.74, 95% CI: 1.11-2.73; P = .015) when pretreatment NLR elevated. Our pooled ORs suggested that NLR had association with International Staging System (ISS), isotype and response to treatment. CONCLUSION The meta-analysis results demonstrated that NLR could predict prognosis in MM patients.
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Solmaz Medeni S, Acar C, Olgun A, Acar A, Seyhanlı A, Taskıran E, Sevindik OG, Alacacıoglu I, Piskin O, Ozcan MA, Demirkan F, Undar B, Ozsan GH. Can Neutrophil-to-Lymphocyte Ratio, Monocyte-to-Lymphocyte Ratio, and Platelet-to-Lymphocyte Ratio at Day +100 be used as a prognostic marker in Multiple Myeloma patients with autologous transplantation? Clin Transplant 2018; 32:e13359. [PMID: 30053318 DOI: 10.1111/ctr.13359] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/11/2018] [Accepted: 07/22/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recent reports have showed that neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) are predictors of progression-free survival (PFS) and overall survival (OS) in many types of cancer. This study evaluates the predictive value of NLR, MLR, and PLR for survival in MM patients treated with to ASCT. METHODS A set of data consisting of 150 patients who underwent autologous stem cell transplantation (ASCT) for MM was collected retrospectively. The prognostic value of NLR, MLR, and PLR was investigated with Kaplan-Meier method. RESULTS The prognostic value of NLR, MLR, and PLR was analyzed by a receiver operating characteristic (ROC) curve established to determine the cutoff. These cutoff values of NLR, PLR, and MLR were found 1.46, 86, and 0.27, respectively, on the 100th day of post-transplantation period. The overall survival (OS) and the post-transplantation OS of the patients with high NLR, MLR, and PLR levels on the 100th day of post-transplantation were shorter than the other group (P = 0.05, P = 0.018 [NLR], P = 0.05, P = 0.002 [MLR], P = 0.000, P = 0.001 [PLR]). The post-transplantation progression-free survival (PFS) of the patients with high NLR, MLR, and PLR levels on the 100th day of post-transplantation was shorter as well (P = 0.036, P = 0.001, P = 0.001, respectively). CONCLUSION As increased NLR, MLR, and PLR predicted poor clinical outcome in MM patients with autologous transplantation in this study, they may serve as cost-effective and rapidly available prognostic biomarkers for these patients.
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Affiliation(s)
| | - Celal Acar
- Hematology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Aybuke Olgun
- Faculty of Medicine Hematology, Dokuz Eylul University, Izmir, Turkey
| | - Alev Acar
- Faculty of Medicine Hematology, Dokuz Eylul University, Izmir, Turkey
| | - Ahmet Seyhanlı
- Faculty of Medicine Hematology, Dokuz Eylul University, Izmir, Turkey
| | - Emin Taskıran
- Faculty of Medicine Hematology, Dokuz Eylul University, Izmir, Turkey
| | | | - Inci Alacacıoglu
- Faculty of Medicine Hematology, Dokuz Eylul University, Izmir, Turkey
| | - Ozden Piskin
- Faculty of Medicine Hematology, Dokuz Eylul University, Izmir, Turkey
| | - Mehmet Ali Ozcan
- Faculty of Medicine Hematology, Dokuz Eylul University, Izmir, Turkey
| | - Fatih Demirkan
- Faculty of Medicine Hematology, Dokuz Eylul University, Izmir, Turkey
| | - Bulent Undar
- Faculty of Medicine Hematology, Dokuz Eylul University, Izmir, Turkey
| | - Guner Hayri Ozsan
- Faculty of Medicine Hematology, Dokuz Eylul University, Izmir, Turkey
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30
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Fernández R, Chon E. Comparison of two melphalan protocols and evaluation of outcome and prognostic factors in multiple myeloma in dogs. J Vet Intern Med 2018; 32:1060-1069. [PMID: 29566439 PMCID: PMC5980396 DOI: 10.1111/jvim.15084] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 12/21/2017] [Accepted: 01/30/2018] [Indexed: 12/14/2022] Open
Abstract
Background Multiple myeloma (MM) in dogs typically is treated with melphalan. A daily melphalan dosing schedule reportedly is well tolerated and associated with favorable outcome. Although anecdotally a pulse dose regimen has resulted in successful responses, little long‐term outcome and safety data is available regarding this dosing regimen for dogs with MM. Hypothesis/objectives (1) To compare outcome and adverse event profiles between pulse dose and daily dose melphalan schedules and (2) to report prognostic factors in dogs with MM treated with melphalan. We hypothesized that both protocols would have similar outcomes and tolerability. Animals Thirty‐eight client‐owned dogs diagnosed with MM receiving pulse dose (n = 17) or daily dose (n = 21) melphalan. Methods Retrospective cohort study assessing outcome and adverse events in dogs receiving either protocol. Risk factors were evaluated for their prognostic relevance. Results Both regimens were well tolerated and similarly effective, with an overall median survival time of 930 days. Renal disease and neutrophil‐to‐lymphocyte ratio (NLR) were negative prognostic factors, whereas hypercalcemia and osteolytic lesions were not prognostic factors in this study population. Conclusions and Clinical Importance Positive results support the use of either dosing regimen for the treatment of dogs with MM, and renal disease and NLR were negative prognostic factors. Prospective, controlled, and randomized studies are warranted to confirm these findings.
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Affiliation(s)
- Ricardo Fernández
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, 53706
| | - Esther Chon
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, 53706.,Madison Veterinary Specialists, Madison, Wisconsin, 53713
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31
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Prognostic meaning of neutrophil to lymphocyte ratio (NLR) and lymphocyte to monocyte ration (LMR) in newly diagnosed Hodgkin lymphoma patients treated upfront with a PET-2 based strategy. Ann Hematol 2018; 97:1009-1018. [PMID: 29442162 DOI: 10.1007/s00277-018-3276-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 02/04/2018] [Indexed: 10/18/2022]
Abstract
Recent reports identify NLR (the ratio between absolute neutrophils counts, ANC, and absolute lymphocyte count, ALC), as predictor of progression-free survival (PFS) and overall survival (OS) in cancer patients. We retrospectively tested NLR and LMR (the ratio between absolute lymphocyte and monocyte counts) in newly diagnosed Hodgkin lymphoma (HL) patients treated upfront with a PET-2 risk-adapted strategy. NLR and LMR were calculated using records obtained from the complete blood count (CBC) from 180 newly diagnosed HL patients. PFS was evaluated accordingly to Kaplan-Meier method. Higher NLR was associated to advanced stage, increased absolute counts of neutrophils and reduced count of lymphocytes, and markers of systemic inflammation. After a median follow-up of 68 months, PFS at 60 months was 86.6% versus 70.1%, respectively, in patients with NLR ≥ 6 or NLR < 6. Predictors of PFS at 60 months were PET-2 scan (p < 0.0001), NLR ≥ 6.0 (p = 0.02), LMR < 2 (p = 0.048), and ANC (p = 0.0059) in univariate analysis, but only PET-2 was an independent predictor of PFS in multivariate analysis. Advanced-stage patients (N = 119) were treated according to a PET-2 risk-adapted protocol, with an early switch to BEACOPP regimen in case of PET-2 positivity. Despite this strategy, patients with positive PET-2 still had an inferior outcome, with PFS at 60 months of 84.7% versus 40.1% (negative and positive PET-2 patients, respectively, p < 0.0001). Independent predictors of PFS by multivariate analysis were PET-2 status and to a lesser extend NLR in advanced stage, while LMR maintained its significance in early stage. By focusing on PET-2 negative patients, we found that patients with NLR ≥ 6.0 or LMR < 2 had an inferior outcome compared to patients with both ratios above the cutoff (78.7 versus 91.9 months, p = 0.01). We confirm NLR as predictor of PFS in HL patients independently from stage at diagnosis. Integration of PET-2 scan, NLR and LMR can result in a meaningful prognostic system that needs to be further validated in prospective series including patients treated upfront with PET-2 adapted-risk therapy.
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32
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Mu S, Ai L, Fan F, Sun C, Hu Y. Prognostic role of neutrophil-lymphocyte ratio in multiple myeloma: a dose-response meta-analysis. Onco Targets Ther 2018; 11:499-507. [PMID: 29416350 PMCID: PMC5788996 DOI: 10.2147/ott.s153146] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background The neutrophil–lymphocyte ratio (NLR), a biomarker for systematic inflammation, has been recently identified as a prognostic factor for various types of both solid and hematologic malignancies. Our study presented here was the first meta-analysis assessing the prognostic role of NLR in multiple myeloma (MM). Methods We systematically searched PubMed, Embase, and ISI Web of Science for relevant studies. Odds ratios (ORs) or hazards ratios (HRs) with corresponding 95% CIs are pooled to estimate the association between NLR and clinicopathological parameters or survival of MM patients. Results Seven trials with 1,971 MM patients were enrolled in the meta-analysis, and the results indicated that elevated pretreatment NLR was significantly associated with advanced tumor stages (International Staging System [ISS] III vs ISS I–II: OR 2.427, 95% CI: 1.268–4.467; and Durie–Salmon III vs Durie–Salmon I–II: OR 1.738, 95% CI: 1.133–2.665). Moreover, increased NLR also predicted poorer overall survival (HR 2.084, 95% CI: 1.341–3.238) and progression-free survival (HR 1.029, 95% CI: 1.016–1.042). And two-stage dose–response meta-analysis revealed linear association between increased NLR and risk of mortality in MM patients. Conclusion We can conclude that MM patients with higher NLR are more likely to have poorer prognosis than those with lower NLR.
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Affiliation(s)
- Shidai Mu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lisha Ai
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fengjuan Fan
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunyan Sun
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Romano A, Laura Parrinello N, Cerchione C, Letizia Consoli M, Parisi M, Calafiore V, Martino E, Conticello C, Di Raimondo F, Alberto Palumbo G. The NLR and LMR ratio in newly diagnosed MM patients treated upfront with novel agents. Blood Cancer J 2017; 7:649. [PMID: 29242558 PMCID: PMC5802528 DOI: 10.1038/s41408-017-0019-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 08/12/2017] [Accepted: 08/23/2017] [Indexed: 12/19/2022] Open
Affiliation(s)
- Alessandra Romano
- Department of Biomedicine and Molecular Medicine, University of Catania, Catania, Italy.
| | | | - Claudio Cerchione
- Hematology, Department of Clinical Medicine, University Federico II, Napoli, Italy
| | - Maria Letizia Consoli
- Division of Hematology, Azienda Policlinico-Vittorio Emanuele-Catania, Catania, Italy
| | - Marina Parisi
- Department of Biomedicine and Molecular Medicine, University of Catania, Catania, Italy.,Division of Hematology, Azienda Policlinico-Vittorio Emanuele-Catania, Catania, Italy
| | - Valeria Calafiore
- Department of Biomedicine and Molecular Medicine, University of Catania, Catania, Italy.,Division of Hematology, Azienda Policlinico-Vittorio Emanuele-Catania, Catania, Italy
| | - Enrica Martino
- Department of Biomedicine and Molecular Medicine, University of Catania, Catania, Italy.,Division of Hematology, Azienda Policlinico-Vittorio Emanuele-Catania, Catania, Italy
| | - Concetta Conticello
- Division of Hematology, Azienda Policlinico-Vittorio Emanuele-Catania, Catania, Italy
| | - Francesco Di Raimondo
- Department of Biomedicine and Molecular Medicine, University of Catania, Catania, Italy.,Division of Hematology, Azienda Policlinico-Vittorio Emanuele-Catania, Catania, Italy
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Seo J, Kim WS, Kim JS, Kim SJ, Lee JH, Hong JS, Lee GW, Oh SY, Lee JH, Yoon DH, Lee WS, Kim HJ, Kwak JY, Kang HJ, Jo JC, Park Y, Lee HS, Kim HJ, Suh C. Platelet to lymphocyte ratio (PLR) retains independent prognostic significance in advanced stage marginal zone lymphoma patients treated with rituximab, cyclophosphamide, vincristine, and prednisone combination chemotherapy (R-CVP): Consortium for Improving Survival of Lymphoma trial. Blood Res 2017; 52:200-206. [PMID: 29043235 PMCID: PMC5641512 DOI: 10.5045/br.2017.52.3.200] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 05/28/2017] [Accepted: 07/07/2017] [Indexed: 12/11/2022] Open
Abstract
Background Rituximab plus cyclophosphamide, vincristine, and prednisone (R-CVP) is one of the effective chemotherapeutic regimens for patients with advanced stage marginal zone lymphoma (MZL). However, prognostic factors that affect the outcome of treatment for MZL are not well understood. Methods Between August 2006 and June 2013, patients with newly diagnosed stage III and IV MZL treated with R-CVP as a first-line therapy from 15 institutions were retrospectively analyzed. Patients' clinical and laboratory data at diagnosis were collected by review of medical records. Results A total of 80 patients were analyzed. Bone marrow involvement was observed in 30% cases. Twelve patients (15%) had nodal MZL, and 41.3% patients exhibited multiple mucosa-associated lymphoma tissue sites. Overall response rate was 91.3%, including 73.8% achieving complete response. Advanced MZL patients treated with R-CVP showed a 3-year progression-free survival (PFS) rate of 69.6%. Prognostic markers significantly affecting PFS in univariate analysis were platelet to lymphocyte ratio (PLR, <95 vs. ≥95, P=0.014), serum albumin (≤3.9 vs. >3.9 g/dL, P=0.008), and the International Prognostic Index (IPI) score (1 vs. 2–4, P=0.032). In multivariate analysis, only PLR (<95 vs. ≥95, HR 0.367, 95% CI, 0.139–0.971, P=0.043) was an independent risk factor for PFS. Conclusion PLR ≥95 at diagnosis is an independent prognostic marker for PFS in advanced stage MZL patients treated with R-CVP. This marker may aid clinicians in predicting the response to R-CVP chemotherapy in stage III and IV MZL patients.
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Affiliation(s)
- Jeongkuk Seo
- Department of Internal Medicine, Dong-A University Hospital, Busan, Korea
| | - Won Seog Kim
- Department of Medicine, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Seok Kim
- Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Jin Kim
- Department of Medicine, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hoon Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Jun Shik Hong
- Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Gyeong-Won Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Sung Yong Oh
- Department of Internal Medicine, Dong-A University Hospital, Busan, Korea
| | - Ji-Hyun Lee
- Department of Internal Medicine, Dong-A University Hospital, Busan, Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won-Sik Lee
- Department of Hemato/Oncology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Hyo Jung Kim
- Department of Internal Medicine, Hallym Medical Center, Hallym University College of Medicine, Anyang, Korea
| | - Jae-Yong Kwak
- Division of Hematology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Hye Jin Kang
- Division of Hematology/Oncology, Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Jae-Cheol Jo
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Yong Park
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ho Sup Lee
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Hyo-Jin Kim
- Department of Internal Medicine, Dong-A University Hospital, Busan, Korea
| | - Cheolwon Suh
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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35
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Shi L, Qin X, Wang H, Xia Y, Li Y, Chen X, Shang L, Tai YT, Feng X, Acharya P, Acharya C, Xu Y, Deng S, Hao M, Zou D, Zhao Y, Ru K, Qiu L, An G. Elevated neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio and decreased platelet-to-lymphocyte ratio are associated with poor prognosis in multiple myeloma. Oncotarget 2017; 8:18792-18801. [PMID: 27852046 PMCID: PMC5386647 DOI: 10.18632/oncotarget.13320] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/20/2016] [Indexed: 01/04/2023] Open
Abstract
Elevated inflammatory markers are associated with poor outcomes in various types of cancers; however, their clinical significance in multiple myeloma (MM) have seldom been explored. This study investigated the prognostic relevance of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) in MM. Totally 559 MM patients were included in this study. NLR, PLR and MLR were calculated from whole blood counts prior to therapy. Kaplan-Meier curves and multivariate Cox proportional models were used for the evaluation of the survival. It has shown that newly diagnosed MM patients were characterized by high NLR and MLR. Elevated NLR and MLR and decreased PLR were associated with unfavorable clinicobiological features. Applying cut-offs of 4 (NLR), 100 (PLR) and 0.3 (MLR), elevated NLR, MLR and decreased PLR showed a negative impact on outcome. Importantly, elevated NLR and decreased PLR were independent prognostic factors for progression-free survival. Thus, elevated NLR and MLR, and decreased PLR predict poor clinical outcome in MM patients and may serve as the cost-effective and readily available prognostic biomarkers.
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Affiliation(s)
- Lihui Shi
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - Xiaoqi Qin
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China.,Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Huijun Wang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - Yonghui Xia
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - Yuanyuan Li
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - Xuejing Chen
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - Lei Shang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - Yu-Tzu Tai
- LeBow Institute for Myeloma Therapeutics and Jerome Lipper Center for Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Xiaoyan Feng
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - Prakrati Acharya
- Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA
| | - Chirag Acharya
- LeBow Institute for Myeloma Therapeutics and Jerome Lipper Center for Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Yan Xu
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - Shuhui Deng
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - Mu Hao
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - Dehui Zou
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - Yaozhong Zhao
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - Kun Ru
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - Lugui Qiu
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - Gang An
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
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Hu L, Li M, Ding Y, Pu L, Liu J, Xie J, Cabanero M, Li J, Xiang R, Xiong S. Prognostic value of RDW in cancers: a systematic review and meta-analysis. Oncotarget 2017; 8:16027-16035. [PMID: 27926498 PMCID: PMC5362543 DOI: 10.18632/oncotarget.13784] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/22/2016] [Indexed: 12/24/2022] Open
Abstract
Red blood cell distribution width (RDW), a parameter that used to differentiate the type of anemia for several decades, recent studies suggest it was a prognostic factor in various types of cancer patients. However, the prognostic value of RDW in cancer patients remains controversial. Here, we performed a meta-analysis and systematic review to evaluate the prognostic value of RDW in cancer patients. Relevant studies were picked out from the databases of Web of Science, Embase, Pubmed and Cochrane Library. A total of 16 papers with 4267 patients were included in this meta-analysis, and the combined results indicated that elevated RDW was associated with poor over survival (OS) (HR = 1.47, 95%CI:1.29-1.66), poor cancer-specific survival (CSS) (HR = 1.46, 95%CI:1.08-1.85), poor disease-free survival (DFS) (HR = 1.91, 95%CI:1.27-2.56), poor event-free survival (EFS) (HR = 2.98, 95%CI:0.57-5.39) and poor progress-free survival (PFS) (HR = 3.21, 95%CI:0.33-6.75) after treatment. Furthermore, the similar results were observed in subgroup analysis stratified by cancer type, cutoff value of RDW, sample size and ethnicity. In conclusion, this meta-analysis demonstrated that RDW may be a potential prognostic marker in patients with cancer, and high RDW may also be associated with poor outcomes.
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Affiliation(s)
- Linhui Hu
- Department of Hematology/Hematological Laboratory, The Second Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Manman Li
- Department of Hematology/Hematological Laboratory, The Second Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Yangyang Ding
- Department of Hematology/Hematological Laboratory, The Second Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Lianfang Pu
- Department of Hematology/Hematological Laboratory, The Second Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Jun Liu
- Department of Hematology/Hematological Laboratory, The Second Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Jingxin Xie
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fudan University, Shanghai, People's Republic of China
| | - Michael Cabanero
- University Health Network, University of Toronto, Ontario, Canada
| | - Jingrong Li
- Department of Emergency, The Second Hospital of Anhui Medical university, Hefei, Anhui, People's Republic of China
| | - Ru Xiang
- School of Nursing, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Shudao Xiong
- Department of Hematology/Hematological Laboratory, The Second Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
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Feng JR, Qiu X, Wang F, Chen PF, Gao Q, Peng YN, Lin X, Liu Q, Liu J, Zhao Q, Li J. Diagnostic Value of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Crohn's Disease. Gastroenterol Res Pract 2017; 2017:3526460. [PMID: 28798770 PMCID: PMC5535728 DOI: 10.1155/2017/3526460] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/16/2017] [Accepted: 05/31/2017] [Indexed: 12/12/2022] Open
Abstract
The aim of this study is to investigate the diagnostic efficacy of neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-monocyte ratio (NMR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) in patients with Crohn's disease (CD) and non-CD controls. These ratios were all derived from complete blood counts. Two hundred and six participants including CD inpatients and non-CD controls were retrospectively enrolled. We found statistically higher NLR and PLR and lower LMR in CD patients than in non-CD controls (all P < 0.01). However, NMR was not different between the two groups (P = 0.18). In addition, NLR, PLR, and LMR were associated with CRP and ESR. Optimal cutoffs for NLR and PLR were 2.72 (sensitivity: 68.3%, specificity: 75.9%, and overall accuracy: 70.1%) and 132.88 (sensitivity: 76.7%, specificity: 84.8%, and overall accuracy: 80.8%), respectively. In conclusion, the NLR and PLR might be effective, readily available, and low-cost biomarkers for differentiating CD patients from non-CD controls.
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Affiliation(s)
- Jue-Rong Feng
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Clinical Center & Key Laboratory of Intestinal & Colorectal Diseases, Wuhan, China
| | - Xiao Qiu
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Clinical Center & Key Laboratory of Intestinal & Colorectal Diseases, Wuhan, China
| | - Fan Wang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Clinical Center & Key Laboratory of Intestinal & Colorectal Diseases, Wuhan, China
| | - Peng-Fei Chen
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Clinical Center & Key Laboratory of Intestinal & Colorectal Diseases, Wuhan, China
| | - Qian Gao
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Clinical Center & Key Laboratory of Intestinal & Colorectal Diseases, Wuhan, China
| | - Ya-Nan Peng
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Clinical Center & Key Laboratory of Intestinal & Colorectal Diseases, Wuhan, China
| | - Xue Lin
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Clinical Center & Key Laboratory of Intestinal & Colorectal Diseases, Wuhan, China
| | - Qing Liu
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Clinical Center & Key Laboratory of Intestinal & Colorectal Diseases, Wuhan, China
| | - Jing Liu
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Clinical Center & Key Laboratory of Intestinal & Colorectal Diseases, Wuhan, China
| | - Qiu Zhao
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Clinical Center & Key Laboratory of Intestinal & Colorectal Diseases, Wuhan, China
| | - Jin Li
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Clinical Center & Key Laboratory of Intestinal & Colorectal Diseases, Wuhan, China
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Li Y, Li H, Li W, Wang L, Yan Z, Yao Y, Yao R, Xu K, Li Z. Pretreatment neutrophil/lymphocyte ratio but not platelet/lymphocyte ratio has a prognostic impact in multiple myeloma. J Clin Lab Anal 2016; 31. [PMID: 27925303 DOI: 10.1002/jcla.22107] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/09/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We evaluated the prognostic significance of neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) in patients with multiple myeloma (MM). METHODS In total, we retrospectively analyzed 315 newly diagnosed MM patients and calculated NLR and PLR from the complete blood count of the untreated patients. We further assessed the role of pretreatment NLR and PLR on overall survival (OS) and progression-free survival (PFS). RESULTS Multiple myeloma patients with high NLR (≥2) experienced shorter OS (P=.02) and PFS (P=.01) compared with patients with low NLR (<2). Furthermore, among the patients with conventional chemotherapy, elderly patients, or patients with advanced stages, high NLR (≥2) was found to have a negative prognostic impact on OS and PFS. In the multivariate Cox analysis, we confirmed that the NLR was an independent prognostic factor for both OS and PFS (P=.000). But the differences in OS or PFS by PLR were not found in MM patients. CONCLUSIONS Our study suggests that NLR not PLR can be acted as an independent prognostic factor for analyzing the clinical outcome of MM patients.
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Affiliation(s)
- Yanjie Li
- Laboratory Center of Diagnostics, Xuzhou Medical University, Xuzhou, China
| | - Hujun Li
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Wenjing Li
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Lijin Wang
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Zhiling Yan
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yao Yao
- Institute of Haematology, Xuzhou Medical University, Xuzhou, China
| | - Ruosi Yao
- Institute of Haematology, Xuzhou Medical University, Xuzhou, China
| | - Kailin Xu
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Zhenyu Li
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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Onec B, Okutan H, Albayrak M, Saribacak Can E, Aslan V, Unver Koluman B, Soyer Kosemehmetoglu O, Albayrak A, Kos DM. The Predictive Role of the Neutrophil/Lymphocyte Ratio in Survival with Multiple Myeloma: A Single Center Experience. J Clin Lab Anal 2016; 31. [PMID: 27500465 DOI: 10.1002/jcla.22032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 07/01/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Recent studies have shown a positive correlation between tumor-related immune response markers and the poor outcome in solid tumors. In this study, we aimed to investigate the neutrophil/lymphocyte ratio (NLR) in multiple myeloma. To the best of our knowledge, this would be the second report concerning this topic. METHODS We retrospectively reviewed the data for 52 multiple myeloma patients. The patients were grouped using the baseline NLR as NLR ≤ 1.72 and NLR > 1.72 using receiver operating characteristic analysis to determine a cut off. We compared the two groups in terms of both the known prognostic factors of the myeloma and the overall survival (OS). RESULTS Our study showed that NLR is associated with C-reactive protein and β2 microglobulin (P = 0.02 and P = 0.001, respectively). The patients with NLR > 1.72 had significantly worse stages, performance status, and kidney functions. The whole group's OS was estimated as 35.1 months while the patients with lower NLR had better OS when compared with those with NLR > 1.72 (42.75 and 26.14 months, respectively, P: 0.04). CONCLUSION Neutrophil/lymphocyte ratio, which is associated with stage, performance status, and kidney functions, can be used in daily practice as a predictor for survival in multiple myeloma. Simply adding NLR to the routine charts may enrich our data for larger studies.
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Affiliation(s)
- Birgul Onec
- Department of Hematology, Dışkapı Training and Research Hospital, Ankara, Turkey
| | - Harika Okutan
- Department of Hematology, Dışkapı Training and Research Hospital, Ankara, Turkey
| | - Murat Albayrak
- Department of Hematology, Dışkapı Training and Research Hospital, Ankara, Turkey
| | - Esra Saribacak Can
- Department of Hematology, Dışkapı Training and Research Hospital, Ankara, Turkey
| | - Vedat Aslan
- Department of Hematology, Dışkapı Training and Research Hospital, Ankara, Turkey
| | - Basak Unver Koluman
- Department of Hematology, Dışkapı Training and Research Hospital, Ankara, Turkey
| | | | - Aynur Albayrak
- Department of Pathology, Dışkapı Training and Research Hospital, Ankara, Turkey
| | - Durdu Mehmet Kos
- Department of Internal Medicine, Faculty of Medicine, Düzce University, Düzce, Turkey
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Uz B. Comment on "Neutrophil to lymphocyte ratio improves the risk assessment of ISS staging in newly diagnosed MM patients treated upfront with novel agents". Ann Hematol 2016; 95:521-2. [PMID: 26747295 DOI: 10.1007/s00277-016-2591-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 12/28/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Burak Uz
- Division of Adult Hematology, Department of Internal Medicine, Gazi University Faculty of Medicine, Göksu Mah., Erzurum Kongre Cad., Göksu Metrokent Sitesi, A-3 Blok, No 26, Eryaman, Ankara, TÜRKİYE.
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