Correlations Of Neutrophil To Lymphocyte Ratio With Immunophenotype And Cytogenetic Abnormalities And Its Effect On Prognosis In Newly Diagnosed MM Patients

?Objective? The difference of Neutrophil to Lymphocyte Ratio(NLR)between patients with newly diagnosed Multiple myeloma(MM)and normal people was compared,to explore the correlations between NLR and clinical characteristics such as immunophenotype and cytogenetic abnormalities in newly diagnosed MM(NDMM)patients.To analyze the value of peripheral blood NLR in the prognosis of patients with multiple myeloma.?Methods? In this study,the clincal data of 236 patients with NDMM in our hospital from December 2011 to January 2019 were analyzed retrospectively,such as lactate dehydrogenase(LDH),creatinine,hemoglobin(Hb),lymphocyte,neutrophil,platelet,calcium,D-S stage,International Classification System(ISS),chromosome karyotype,immunophenotype,FISH,sex,age,etr.We collected the 236 NDMM patients and 35 healthy people as the research object.The NLR was calculated by the blood routine.Then,we analyzed the difference of NLR between MM patients and the control group.The cut-off value of NLR determined by using ROC cure was 4,the patients of MM were divided into NLR?4 group(n= 166 cases)and NLR>4 group(n= 70 cases).To analyze the relationship between NLR,chromosome karyotype and immunophenotype,and analyzed the influence of various factors on the prognosis survival of patients.The survival analysis used the Kaplan-Meier method by drawing survival curves.Independent prognostic factors of patients of NDMM was determined by multivariate COX analysis.?Results?(1)Among the 236 patients of multiple myeloma,there were 147 male and 89 female patients.The age at diagnosis was 30-88 years and the median age was 62 years.Among them,60-70 years,50-60 years and 70-80 years old people accounted for 39%,23.35% and 21.2%,respectively.Ig G is the most common type of NDMM,accounting for 47%.According to DS stage,the patients with stage I,II,III were 7.2%(17/236 cases),14.0%(33/236 cases),and 78.8%(186/236 cases),respectively.According to ISS stage,the patients with stage I,II,III were 22.5%(53/236 cases),30.1%(71/236 cases)and 47.5%(112/236 cases),respectively.(2)People with NLR>4 had lower Hb,lower platelet,EMD and complex karyotype than those in people with NLR?4(P < 0.05).In terms of both the depth response rate(?VGPR%)and the total response rate(?PR%),the treatment response of patients in NLR?4 group was better than that in NLR>4 group.The incidence of CD56 negative,TP53 and RB-1 positive The incidence of CD56-negative,TP53 and RB-1 positive was higher in patients with high NLR group(P <0.05).Other clinical characteristics had no significant difference,such as age,sex,typing,creatinine,LDH,etc(P>0.05).(3)The survival analysis of patients between NLR>4 group and NLR?4 group showed that the survival curves of patients were significantly different.Patients with NLR>4 had lower OS and PFS.Among the patients who received the new drugs,survival curve between two groups had no significant difference(P >0.05).In univariate analysis,CD56-,TP53,RB-1,1q,EMD,Hb?85g/L,and NLR >4 were significantly related to progression-free survival(PFS)(P <0.05).CD56-,TP53,1q,EMD,Hb?85g/L,NLR>4,LDH?200U/L were related to the overall survival(OS)(P<0.05).Multivariate analysis showed that NLR >4 and TP53 were independent risk factors for PFS,and NLR >4,TP53,1q and Hb?85g/L were independent risk factors for OS.?Conclusions?(1)Patients in NLR?4 group had better treatment response than those in NLR>4 group,and it was easier to obtain deep remission rate.(2)High NLR level in peripheral blood of NDMM patients had a shorterprognosis.NLR can be used as a supplementary index to predict the prognosis of patients except ISS stage and DS stage.(3)The treatment regiments based on Btz can improve the poor prognosis of high NLR.