The Prognostic Significance of Neutrophil to Lymphocyte Ratio in Patients with Multiple Myeloma

Year 2020, Volume: 3 Issue: 3, 186 - 194, 05.11.2020

Alpay Medetalibeyoğlu , Nur Akyüz Sena Bayrakdar Mustafa Altınkaynak , Timur Akpınar , Cemil Taşçıoğlu

Abstract

Objective: The neutrophil-to-lymphocyte ratio(NLR) is a biomarker for systematic inflammation. It is also thought that the NLR can be used as a new biomarker by clinicians in predicting the prognosis of patients with multiple myeloma(MM). This study, aimed to retrospectively investigate the prognostic significance of pretreatment NLR in patients with MM, based on the hypothesis that elevated pretreatment NLR is a biomarker indicating worse survival in patients with MM. Materials and Methods: Patients aged >18 years with MM diagnosed, follow-up, and treated between January 2011 and December 2017 in the department of internal and geriatric medicine at Istanbul Faculty of Medicine were enrolled into this study. We retrospectively collected the data of 40 patients from the medical records. The relationship between NLR and baseline characteristics, laboratory parameters, prognosis, and survival outcome was analyzed. Results: The study showed that the mean NLR was 2.84±2.62 (0.1-14.8) in the whole blood count. No significant correlation was found between NLR and mortality (p=0.965). A significant relationship was found between higher stage and mortality (p=0.035). In addition, anemia, low albumin level, and elevated lactate dehydrogenas (LDH) level indicated poor survival time in patients with MM (p=0.022; p=0.031; p=0.023). Conclusion: Our study showed no relationship between NLR and both mortality and overall survival (OS). The above result can be explained by the fact that our study had some limitations such as the use of retrospective data from a single-center and the small sample size.

Keywords

overall survival, Multiple myeloma, neutrophil-lymphocyte ratio

Multiple Miyelom Hastalarında Nötrofil Lenfosit Oranının Prognostik Önemi

Abstract

Amaç: Nötrofil-lenfosit oranı (NLR), bir sistematik inflamasyon biyobelirtecidir. Multipl miyelomlu (MM) hastalar için de NLR'nin prognozu öngörmede yeni bir biyobelirteç olarak klinisyene yardımcı olabileceği düşünülmektedir. Bu çalışmada, tedavi öncesi NLR'nin MM hastalarında daha kötü bir sağkalım biyobelirteci olduğu hipotezine dayanarak, MM'lu hastalarda tedavi öncesi NLR'nin prognostik önemini retrospektif olarak araştırmayı amaçladık. Gereç ve Yöntem: Çalışmaya, İstanbul Tıp Fakültesi İç Hastalıkları ve Geriatri Anabilim Dalı'nda Ocak 2011 - Aralık 2017 tarihleri arasında tanı, takip ve tedavi gören 18 yaş üstü MM hastaları alındı. 40 hastanın verileri tıbbi kayıtlardan retrospektif olarak toplandı. NLR ile temel özellikler, laboratuvar parametreleri, prognoz ve sağkalım arasındaki ilişki analiz edildi. Bulgular: Mevcut çalışma, tam kan sayımında ortalama NLR'nin 2,84±2,62 (0,1-14,8) olduğunu gösterdi. NLR ile mortalite arasında anlamlı bir ilişki bulunmadı (p=0,965). Yüksek evre ile ölüm arasında anlamlı bir ilişki vardır (p=0,035). Ayrıca anemi, düşük albümin düzeyi ve yüksek laktat dehidrogenaz (LDH) düzeyi MM'lu hastalarda kötü sağkalım süresine işaret ediyordu (p=0,022; p=0,031; p=0,023). Sonuç: Çalışmamız NLR ile mortalite ve genel sağkalım (OS) arasında bir ilişki olmadığını gösterdi. Çalışmamızda NLR ile mortalite ve OS arasında bir ilişkinin olmamasının nedeni, çalışmamızın tek merkezden geriye dönük verilerin toplanması ve küçük örneklem büyüklüğü gibi bazı sınırlılıklara sahip olması olabilir.

Keywords

Multiple myelom, nötrofil lenfosit oranı, genel sağkalım

References

• 1. Spicka I. Advances in multiple myeloma therapy during two past decades. Comput Struct Biotechnol J 2014;10(16):38-40.
• 2. Hameed A, Brady JJ, Dowling P, Clynes M, O’Gorman P. Bone disease in multiple myeloma: pathophysiology and management. Cancer Growth Metastasis 2014;7:33-42.
• 3. Jameson JL, Kasper DL, Hauser SL, Longo DL, Fauci AS, Loscalzo J, editors. Harrison’s principles of internal medicine 2018. Published by McGraw Hill Medical Books.
• 4. Kelkitli E, Atay H, Çilingir F, Güler N, Terzi Y, Özatlı D, et al. Predicting survival for multiple myeloma patients using baseline neutrophil/ lymphocyte ratio. Ann Hematol 2014;93(5):841-6.
• 5. Wongrakpanich S, George G, Chaiwatcharayut W, Biso S, Candelario N, Mittal V, et al. The Prognostic Significance of Neutrophil-to- Lymphocyte and Platelet-to-Lymphocyte Ratios in Patients With Multiple Myeloma. J Clin Lab Anal 2016;30(6):1208-13.
• 6. Shi L, Qin X, Wang H, Xia Y, Li Y, Chen X, et al. 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(12):18792-801.
• 7. Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos M-V, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol 2014;15(12):e538-e48.
• 8. Greipp PR, Miguel JS, Durie BG, Crowley JJ, Barlogie B, Bladé J, et al. International staging system for multiple myeloma. J Clin Oncol 2005;23(15):3412-20.
• 9. Solmaz S, Uzun O, Acar C, Sevindik O, Piskin O, Ozsan H, et al. Is the platelet-to-lymphocyte ratio a new prognostic marker in multiple myeloma?. J Lab Physicians 2018;10(4):363-9.
• 10. Willenbacher E, Weger R, Rochau U, Siebert U, Willenbacher W. Real-World Use of 3rd Line Therapy for Multiple Myeloma in Austria: An Austrian Myeloma Registry (AMR) Analysis of the Therapeutic Landscape and Clinical Outcomes prior to the Use of Next Generation Myeloma Therapeutics. PLoS One 2016;11(3):e0147381.
• 11. Zhao Q, Li F, Song P, Zhou X, An Z, Mei J, et al. Poor outcomes of immunoglobulin D multiple myeloma patients in the era of novel agents: a single-center experience. Cancer Commun (Lond) 2019;39(1):51.
• 12. Andriandi, Kamal AF. Survival rate of multiple myeloma patients in Indonesia: A retrospective study in multiple myeloma at a single institution. Ann Med Surg (Lond.) (2019). 2019;41:11-5.
• 13. Acquah ME, Hsing AW, McGuire V, Wang S, Birmann B, Dei-Adomakoh Y. Presentation and survival of multiple myeloma patients in Ghana: a review of 169 cases. Ghana Med J 2019;53(1):52-8.
• 14. Birgegard G, Gascon P, Ludwig H. Evaluation of Anaemia İn Patients With Multiple Myeloma And Lymphoma: Findings of the European Cancer Anaemıa Survey. Eur J Haematol 2006;77(5):378-86.
• 15. Atallah JP, Azab B, Vivekanandarajah A, Naboush A, Sater HA, Farhan M, et al. Elevated Neutrophil: Lymphocyte Ratio Does Not Predict Survival In Multiple Myeloma Patients. Blood 2013;122(21):5336.
• 16. Rossi D, Fangazio M, De Paoli L, Puma A, Riccomagno P, Pinto V, et al. Beta-2- microglobulin is an independent predictor of progression in asymptomatic multiple myeloma. Cancer 2010;116(9):2188-200.
• 17. Gu Y, Yuan Y-H, Xu J, Shi Q-L, Qu X-Y, Guo R, et al. High serum lactate dehydrogenase predicts an unfavorable outcome in Chinese elderly patients with multiple myeloma. Oncotarget 2017;8(29):48350-61.
• 18. Patel KK, Orlowski RZ, Weber DM, Wang M, Thomas SK, Shah JJ, et al. Prognostic value of serum lactate dehydrogenase in symptomatic multiple myeloma. J Clin Oncol 2012.
• 19. Gkotzamanidou M, Kastritis E, Gavriatopoulou MRMMM, Nikitas N, Gika D, Mparmparousi D, et al. Increased serum lactate dehydrongenase should be included among the variables that define very-high-risk multiple myeloma. Clin Lymphoma Myeloma Leuk 2011;11(5):409-13.
• 20. Caro JJ, Salas M, Ward A, Goss GJC. Anemia as an independent prognostic factor for survival in patients with cancer: a systematic, quantitative review. Cancer 2001;91(12):2214-21.
• 21. San Miguel JF, Sanchez J, Gonzalez MJBjoc. Prognostic factors and classification in multiple myeloma. Br J Cancer 1989;59(1):113.
• 22. Jung S-H, Kim JS, Lee WS, Oh SJ, Ahn J-S, Yang D-H, et al. Prognostic value of the inverse platelet to lymphocyte ratio (iPLR) in patients with multiple myeloma who were treated up front with a novel agent-containing regimen. Ann Hematol 2016;95(1):55-61.
• 23. Zhou X, Wang J, Xia J, Cheng F, Mao J, Zhu J, et al. Evaluation of neutrophil-to-lymphocyte ratio in newly diagnosed patients receiving bortezomib- based therapy for multiple myeloma. Cancer Biomark 2018;22(1):43-8.
• 24. Mihou D, Katodritou E, Zervas KJH. Multiple myeloma staging based on the combination of beta-2-microglobulin and albumin: the role of albumin in the model. Hematology 2007;12(6):527-31.
• 25. Scudla V, Budikova M, Fischerova E, Zadrazil J, Indrak K. Stratification of multiple myeloma according to serum beta 2-microglobulin and serum albumin levels. Acta Univ Palacki Olomuc Fac Med 1991;130:201-12.
• 26. Bataille R, Durie B, Grenier J, Sany JJJoCO. Prognostic factors and staging in multiple myeloma: a reappraisal. J Clin Oncol 1986;4(1):80-7.