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 |
