Journal of Laboratory Physicians, Table of Contents

CC BY-NC-ND 4.0 · J Lab Physicians 2018; 10(04): 363-369
DOI: 10.4103/JLP.JLP_36_18

Original Article

Is the platelet-to-lymphocyte ratio a new prognostic marker in multiple myeloma?

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 University, Istanbul

,

Ozden Piskin

Department of Hematology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey

,

Hayri Guner Ozsan

Department of Hematology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey

,

Fatih Demirkan

Department of Hematology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey

,

Bulent Undar

Department of Hematology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey

,

Ahmet Alacacioglu

Faculty of Oncology, Katip Çelebi University, Izmir, Turkey

,

Mehmet Ali Ozcan

Department of Hematology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey

,

Inci Alacacioglu

Department of Hematology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey

› Author Affiliations

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.

Keywords

Keywords

Multiple myeloma - neutrophil-to-lymphocyte ratio - new prognostic marker - platelet-to-lymphocyte ratio

REFERENCES
1 Spicka I. Advances in multiple myeloma therapy during two past decades. Comput Struct Biotechnol J 2014;10:38-40.
2 Röllig C, Knop S, Bornhäuser M. Multiple myeloma. Lancet 2015;385:2197-208.
3 Snozek CL, Katzmann JA, Kyle RA, Dispenzieri A, Larson DR, Therneau TM, et al. Prognostic value of the serum free light chain ratio in newly diagnosed myeloma: Proposed incorporation into the international staging system. Leukemia 2008;22:1933-7.
4 Naymagon L, Abdul-Hay M. Novel agents in the treatment of multiple myeloma: A review about the future. J Hematol Oncol 2016;9:52.
5 Yang HH, Ma MH, Vescio RA, Berenson JR. Overcoming drug resistance in multiple myeloma: The emergence of therapeutic approaches to induce apoptosis. J Clin Oncol 2003;21:4239-47.
6 Ege H, Gertz MA, Markovic SN, Lacy MQ, Dispenzieri A, Hayman SR, et al. Prediction of survival using absolute lymphocyte count for newly diagnosed patients with multiple myeloma: A retrospective study. Br J Haematol 2008;141:792-8.
7 Greipp PR, San Miguel J, Durie BG, Crowley JJ, Barlogie B, Bladé J, et al. International staging system for multiple myeloma. J Clin Oncol 2005;23:3412-20.
8 Santoni M, De Giorgi U, Iacovelli R, Conti A, Burattini L, Rossi L, et al. Pre-treatment neutrophil-to-lymphocyte ratio may be associated with the outcome in patients treated with everolimus for metastatic renal cell carcinoma. Br J Cancer 2013;109:1755-9.
9 Williams KA, Labidi-Galy SI, Terry KL, Vitonis AF, Welch WR, Goodman A, et al. Prognostic significance and predictors of the neutrophil-to-lymphocyte ratio in ovarian cancer. Gynecol Oncol 2014;132:542-50.
10 Kelkitli E, Atay H, Cilingir F, Güler N, Terzi Y, Ozatli D, et al. Predicting survival for multiple myeloma patients using baseline neutrophil/lymphocyte ratio. Ann Hematol 2014;93:841-6.
11 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;30:1208-13.
12 Porrata LF, Ristow K, Habermann T, Inwards DJ, Micallef IN, Markovic SN, et al. Predicting survival for diffuse large B-cell lymphoma patients using baseline neutrophil/lymphocyte ratio. Am J Hematol 2010;85:896-9.
13 Feng JF, Huang Y, Liu JS. Combination of neutrophil lymphocyte ratio and platelet lymphocyte ratio is a useful predictor of postoperative survival in patients with esophageal squamous cell carcinoma. Onco Targets Ther 2013;6:1605-12.
14 Salman T, Kazaz SN, Varol U, Oflazoglu U, Unek IT, Kucukzeybek Y, et al. Prognostic value of the pretreatment neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio for patients with neuroendocrine tumors: An izmir oncology group study. Chemotherapy 2016;61:281-6.
15 Takizawa H, Boettcher S, Manz MG. Demand-adapted regulation of early hematopoiesis in infection and inflammation. Blood 2012;119:2991-3002.
16 Bryant C, Suen H, Brown R, Yang S, Favaloro J, Aklilu E, et al. Long-term survival in multiple myeloma is associated with a distinct immunological profile, which includes proliferative cytotoxic T-cell clones and a favourable treg/Th17 balance. Blood Cancer J 2013;3:e148.
17 Guthrie GJ, Charles KA, Roxburgh CS, Horgan PG, McMillan DC, Clarke SJ, et al. The systemic inflammation-based neutrophil-lymphocyte ratio: Experience in patients with cancer. Crit Rev Oncol Hematol 2013;88:218-30.
18 Luo G, Guo M, Liu Z, Xiao Z, Jin K, Long J, et al. Blood neutrophil-lymphocyte ratio predicts survival in patients with advanced pancreatic cancer treated with chemotherapy. Ann Surg Oncol 2015;22:670-6.
19 Templeton AJ, McNamara MG, Šeruga B, Vera-Badillo FE, Aneja P, Ocaña A, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: A systematic review and meta-analysis. J Natl Cancer Inst 2014;106:dju124.
20 Romano A, Parrinello NL, Consoli ML, Marchionni L, Forte S, Conticello C, et al. Neutrophil to lymphocyte ratio (NLR) improves the risk assessment of ISS staging in newly diagnosed MM patients treated upfront with novel agents. Ann Hematol 2015;94:1875-83.
21 Atallah JP, Mohammad F, Bhat A, Patel NJ, Azab B, Vivekanandrajah A, et al. Elevated neuthrophil: Lymphocyte ratio does not predict survival in multipl myeloma patients. Blood 2013;122:5336.
22 Baranyai Z, Krzystanek M, Jósa V, Dede K, Agoston E, Szász AM, et al. The comparison of thrombocytosis and platelet-lymphocyte ratio as potential prognostic markers in colorectal cancer. Thromb Haemost 2014;111:483-90.
23 Jung SH, Kim JS, Lee WS, Oh SJ, Ahn JS, Yang DH, 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;95:55-61.
24 Eleftherakis-Papapiakovou E, Kastritis E, Roussou M, Gkotzamanidou M, Grapsa I, Psimenou E, et al. Renal impairment is not an independent adverse prognostic factor in patients with multiple myeloma treated upfront with novel agent-based regimens. Leuk Lymphoma 2011;52:2299-303.
25 Ozkurt ZN, Yağci M, Sucak GT, Kirazli S, Haznedar R. Thrombopoietic cytokines and platelet count in multiple myeloma. Platelets 2010;21:33-6.
26 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;8:18792-801.
27 Takagi S, Tsukamoto S, Park J, Johnson KE, Kawano Y, Moschetta M, et al. Platelets enhance multiple myeloma progression via IL-1β upregulation. Clin Cancer Res 2018;24:2430-9.
28 Fritz E, Ludwig H, Scheithauer W, Sinzinger H. Shortened platelet half-life in multiple myeloma. Blood 1986;68:514-20.
29 Onec B, Okutan H, Albayrak M, Saribacak Can E, Aslan V, Unver Koluman B, et al. The predictive role of the neutrophil/Lymphocyte ratio in survival with multiple myeloma: A Single center experience. J Clin Lab Anal 2017;31:2-8.
30 Li Y, Li H, Li W, Wang L, Yan Z, Yao Y, et al. Pretreatment neutrophil/lymphocyte ratio but not platelet/lymphocyte ratio has a prognostic impact in multiple myeloma. J Clin Lab Anal 2017;31: e22107.