衍生中性粒细胞与淋巴细胞比值是移植不合格的多发性骨髓瘤患者的独立预后因素。
The Derived Neutrophil-to-Lymphocyte Ratio Is an Independent Prognostic Factor in Transplantation Ineligible Patients with Multiple Myeloma.
作者信息
Lee Gyeong-Won, Park Sung Woo, Go Se-Il, Kim Hoon-Gu, Kim Min Kyoung, Min Chang-Ki, Kwak Jae-Yong, Bae Sang-Byung, Yoon Sung-Soo, Lee Je-Jung, Kim Ki Hwan, Nam Seung-Hyun, Mun Yeung-Chul, Kim Hyo Jung, Bae Sung Hwa, Shin Ho-Jin, Lee Jung-Hee, Park Joon Seong, Jeong Seong Hyun, Lee Mark Hong, Lee Ho Sup, Park Keon Woo, Lee Won-Sik, Lee Sang Min, Lee Jeong-Ok, Hyun Myung Soo, Jo Deog Yeon, Lim Sung-Nam, Lee Jae Hoon, Kim Hawk, Cho Do-Yeun, Do Young Rok, Kim Jeong-A, Park Seong Kyu, Kim Jin Seok, Kim Soo-Jeong, Yi Hyeon Gyu, Moon Joon Ho, Choi Chul Won, Kim Sung-Hyun, Kim Byung Soo, Park Moo-Rim, Shim Hyeok, Song Moo-Kon, Kim Youngdoe, Kim Kihyun
机构信息
Department of Internal Medicine, Gyeongsang National University Hospital, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju, Republic of Korea.
Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Changwon, Republic of Korea.
出版信息
Acta Haematol. 2018;140(3):146-156. doi: 10.1159/000490488. Epub 2018 Sep 25.
BACKGROUND
The neutrophil-to-lymphocyte ratio (NLR) is an independent prognostic marker in solid and hematological cancers. While the derived NLR (dNLR) was shown to be non-inferior to the NLR in large cohorts of patients with different cancer types, it has not been validated as a prognostic marker for multiple myeloma (MM) to date.
METHODS
Between May 22, 2011 and May 29, 2014, 176 patients with MM from 38 centers who were ineligible for autologous stem cell transplantation were analyzed. The dNLR was calculated using complete blood count differential data. The optimal dNLR cut-off value according to receiver operating characteristic analysis of overall survival (OS) was 1.51. All patients were treated with melphalan and prednisone combined with bortezomib.
RESULTS
The complete response rate was lower in the high dNLR group compared to the low dNLR group (7 vs. 26.1%, respectively; p = 0.0148); the corresponding 2-year OS rates were 72.2 and 84.7%, respectively (p = 0.0354). A high dNLR was an independent poor prognostic factor for OS (hazard ratio 2.217, 95% CI 1.015-4.842; p = 0.0458).
CONCLUSION
The dNLR is a readily available and cheaply obtained parameter in clinical studies, and shows considerable potential as a new prognostic marker for transplantation-ineligible patients with MM.
背景
中性粒细胞与淋巴细胞比值（NLR）是实体癌和血液系统癌症的独立预后标志物。虽然在不同癌症类型的大量患者队列中，衍生NLR（dNLR）被证明不劣于NLR，但迄今为止，它尚未被验证为多发性骨髓瘤（MM）的预后标志物。
方法
2011年5月22日至2014年5月29日，对来自38个中心的176例不符合自体干细胞移植条件的MM患者进行了分析。使用全血细胞计数分类数据计算dNLR。根据总生存期（OS）的受试者工作特征分析，最佳dNLR临界值为1.51。所有患者均接受美法仑、泼尼松联合硼替佐米治疗。
结果
高dNLR组的完全缓解率低于低dNLR组（分别为7%和26.1%；p = 0.0148）；相应的2年OS率分别为72.2%和84.7%（p = 0.0354）。高dNLR是OS的独立不良预后因素（风险比2.217，95%CI 1.015 - 4.842；p = 0.0458）。
结论
dNLR是临床研究中易于获得且成本低廉的参数，对于不符合移植条件的MM患者，它作为一种新的预后标志物显示出巨大潜力。
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