Immature Reticulocyte Fraction and Absolute Neutrophil Count as Predictor of Hemopoietic Recovery in Patients with Acute Lymphoblastic Leukemia on Remission Induction Chemotherapy

Usefulness of baseline immature reticulocyte fraction to mature reticulocyte fraction ratio (IMR) as A prognostic predictor for patients with small cell lung cancer

Background

Small cell lung cancer (SCLC) has a strong invasive ability and a high degree of malignancy, so accurate prognosis prediction is crucial for making the most favorable treatment decision.Unfortunately, there is a scarcity of prognostic indicators specific to SCLC. Reticulocyte levels in blood parameters have been linked to the prognosis of various malignancies. Given SCLC's aggressive characteristics, identifying reliable prognostic markers, such as reticulocyte counts, becomes pivotal in enhancing prognostic accuracy and guiding effective therapeutic strategies.

Objective

This study aimed to evaluate the predictive power of the immature reticulocyte fraction (IRF) to mature reticulocyte fraction (MRF) ratio (IMR) for survival outcomes in patients with SCLC.

Materials and methods

A retrospective analysis was conducted on 192 patients with small cell lung cancer (SCLC). The median values of various prognostic indicators, such as IMR, IRF, MRF, reticulocyte count (RET), SII (systemic immune-inflammatory index), were utilized as cutoff points, categorizing patients into high and low groups. The Kaplan-Meier method, univariate, multivariate analyses Cox regression, and C-index were used to analyze the prognostic factors for overall survival (OS).

Results

In our cohort, 138 (71.9 %) were male, 119 (62 %) were smokers, and 82 (57.3 %) were older than 60 years old. The median survival time was 18.15 months.Higher mortality was observed in the high IMR and high IRF groups, while the high MRF group exhibited lower mortality. At the same time, mortality was lower in the high MRF group. Univariate analysis showed that smoking history (P = 0.006), tumor stage (P = 0.002), chemotherapy cycle (P = 0.014), IMR (P = 0.01), and many other factors significantly affected the prognosis of SCLC. Multivariate analysis demonstrated that elevated IMR was an independent adverse predictor of OS (P = 0.039, HR = 0.330). Spearman test confirmed that the prognostic indicators IRF, IMR, and SII were positively correlated with the overall survival rate of patients with SCLC. Kaplan-Meier analysis showed that the OS rate of patients with high IMR was significantly worse (P = 0.0096). In addition, we found that IMR was superior to IRF in distinguishing patients with different outcomes in the low and high groups (P < 0.05). Our novel integration index, combining IMR with the TNM stage system and SII index, exhibited superior prognostic value compared to the original index. Additionally, the combination of prognostic indicators IMR and SII significantly stratified stage I-II SCLC patients (P ＜0.05).

Conclusions

The prognostic index based on peripheral blood IMR stands out as an independent predictor for SCLC patients pre-treatment. Its accessibility through routine blood analysis facilitates immediate clinical application without requiring prolonged scientific research validation. The integration of IMR with the TNM score enhances survival prediction and risk stratification. Notably, when combined with the SII score, the new IMR index demonstrates significant improvements in prognostication for stage I-II small cell lung cancer.

Morphometric properties of immature reticulocytes in health and during acute lymphoblastic and acute myeloid leukemia

Despite significant advances, many changes occurring in the tumor microenvironment during acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) remain unclear. The surface of immature reticulocytes was examined by atomic force microscopy (AFM) to determine specific changes during the development of ALL and AML. In patients with ALL the surface area of reticulocytes increased by 18.5 %, volume by 8.7 %, the width of invaginations by 18 %, and cell height decreased by 7.8 %. In patients with AML, the volume increased by 12.6 %, roughness by 35.5 %, the height of protrusions by 36.2 %, the depth of invaginations by 24.8 %, their width by 18.2 %, and the maximum height difference of the surface by 31.9 %. The obtained data¹ has important prognostic value in studying the bone marrow activity during acute leukemia.

Cytokinetic parameters of erythropoiesis under normal health conditions and during the development of acute lymphoblastic and acute myeloblastic leukemia

The article presents the application of the method for determining the quantitative parameters of erythropoiesis to patients with acute leukemia. The objective of the work is an investigation of erythropoiesis cytokinetic parameters under the normal health conditions and during the development of the acute lymphoblastic leukemia and the acute myeloblastic leukemia. It was found that the distribution of reticulocytes shifts towards an increase of immature reticulocyte fraction while the ratio between maturing and immature cells remains unchanged. The method presented can be used in clinical diagnostic and scientific research of bone marrow hematopoietic activity.