TITLE:
The Lower Peripheral Blood Lymphocyte to Monocyte Ratio Following Completion of First Line Chemotherapy Is a Risk Factor for Predicting Relapse in Patients with Diffuse Large B-Cell Lymphoma
AUTHORS:
Ghada Ezzat Eladawei, Sheref Mohamed El-Taher
KEYWORDS:
Diffuse Large B Cell Lymphoma, Absolute Lymphocyte Count/Absolute Monocyte Count Ratio, Relapse, Follow up
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.10 No.1,
January
23,
2019
ABSTRACT: Background and
objective: During routine follow up, there is no specific
predictor to ascertain relapse after standard first line chemotherapy in
diffuse large cell lymphoma. Therefore, this study was designed to assess the
prognostic significance of the ratio between absolute lymphocyte and monocyte
counts (LMR) in the peripheral blood to verify relapse in diffuse large B cell
lymphoma. Patients and methods: A total of 139 patients with newly diagnosed diffuse large B cell lymphoma (DLBCL)
were evaluated and treated with CHOP or R-CHOP between the years 2009 and 2016.
Three months following completion of first line therapy, Lymphocyte/monocyte
ratio (LMR) was calculated from the routine automated complete blood cell count
(CBC) attained a plateau after the bone marrow recovery after first line
chemotherapy. The absolute lymphocyte count/absolute monocyte count ratio (LMR)
was calculated by dividing the ALC by the AMC. Results: ROC curve
analysis of 139 patients established 2.8 as cutoff point of LMR for relapse
with AUC of 0.97 (95% CI 0.93 - 0.99, P ≤ 0.001). Cox regression analysis was
performed to identify factors predicting relapse. In univariate regression
analysis, ALC (95% CI 0.003 - 0.03, p ≤ 0.001), AMC (95% CI 15.4 - 128.8, p ≤
0.001), LMR (95% CI 0.001 - 0.01, p ≤ 0.001), and LDH (95% CI 0.1 -
0.5, p ≤ 0.001) following completion of therapy are significant factors for
relapse. Other significant factors for relapse are Ann Arbor stage (95% CI 1.1 -
6.9, P = 0.03), extranodal sites (95% CI 1.2 - 6.1, P = 0.01), age (95% CI 1.3 -
6.5, P = 0.01) and treatment of CHOP protocol (95% CI 0.05 - 0.6, P = 0.007). In a
multivariate analysis LMR following completion of therapy was predictive for
relapse (95% CI 0.001 - 0.2, P = 0.005). ALC was also significant in
multivariate analysis (95% CI 0.01 - 0.8, P = 0.03). LDH following completion
of therapy (95% CI 0.2 - 14.9, P = 0.5), AMC following completion of therapy
(95% CI 0.3 - 43.1, P = 0.3), age (95% CI 0.9 - 205.4, P = 0.06), extra-nodal
sites (95% CI 0.04 - 9.8, P = 0.8), Ann Arbor stage (95% CI 0.3 - 28.7, P =
0.3), and Treatment of CHOP protocol (95% CI 0.01 - 2.4, P =
0.2) were not statistically significant. Conclusion: This study
observed that LMR assessed after first line chemotherapy during routine follow
up is an independent predictor of relapse and clinical outcome in DLBCL
patients. LMR at follow up can be used a simple inexpensive biomarker to alert
clinicians for relapse during follow up after standard first line chemotherapy
in DLBCL patients.