The Prognostic Significance Of Peripheral Blood Mononuclear Cell Count, Lymphocyte Count And Its Ratio In Lymphoma

Part onePrognostic significance of peripheral blood monocyte count,lymphocyte count and lymphocyte to monocyte ratio in Hodgkin lymphomaObjectiveHodgkin lymphoma(HL)is one of the most common types of lymphoma in clinic,with relatively good efficacy of chemotherapy and long survival time,but there are also about 20%of patients with poor treatment effect,and excessive treatment and chemotherapy drug long-term toxicity and other issues.Currently,the International Prognostic Score(IPS),which is widely used in clinics,has certain limitations.It is necessary to analyze and integrate the newly emerging prognostic factors such as absolute monocyte count(AMC),absolute lymphocyte count(ALC),and lymphocyte to monocyte ratio(LMR)in the peripheral blood,and to study more appropriate prognostic factors and accurate prognostic stratification in order to improve the efficacy and reduce adverse events.In our study,the prognostic significance of peripheral blood AMC,ALC and LMR in HL and its relationship with other prognostic factors were discussed.MethodsThis study included 133 patients with HL with confirmed clinical data from the Jiangsu Province Hospital between January 2007 to March 2016.The patient's clinical prognostic factors at the time of the initial diagnosis were recorded,such as gender,age,Ann-Arbor stage,B symptoms,Eastern Cooperative Oncology Group Performance Status(ECOG PS),IPS score,bone marrow involvement(BMI),extranodal site involvement(ESI),ALC,AMC,LMR,hemoglobin,(Hb),platelet(PLT),and serum lactate dehydrogenase(LDH).We followed up for the overall survival(OS)and the progression-free survival(PFS)from those patients,and found the optimal cut-off values of AMC,ALC and LMR,compared the relationship between them and other factors.We performed multivariate and univariate survival analysis of OS and PFS,and the comprehensive evaluation of LMR combined with the PET2 from 56 patients was also carried out.ResultsCompared AMC,ALC with other prognostic factors,ALC was found decreased significantlyin in 6 groups:Older than 45 years,ECOG PS?2,ESR?50 mm/h,hemoglobin<105 g/L,IPS 3-7 points,and treatment NR group were significantly lower.Patients with an ECOG PS>2 group had significantly lower AMC than patients with better performance status.The optimal cut-off values for ALC,AMC,and LMR were 0.6�109/L,0.7�109/L and 0.25,respectively,which are similar to those reported in other studies.Univariate survival analysis revealed that Male,Ann-Arbor stage IV,Involved nodal sites>3,ECOG PS?2,Hb<105 g/L,ALC<0.6�109/L,AMC>0.7�109/L,LMR<2.5,ALB<40g/1,IPS3-7 points,NR showed poor PFS.And Male,Ann-Arbor stage IV,B symptoms,Involved nodal sites?3,ECOG PS?2,ESR?50 mm/h,Hb<105 g/L,ALC<0.6�109/L,AMC>0.7�109/L,LMR<2.5,ALB<40 g/L,IPS 3-7 points,ESI,BMI,NR were poor prognostic factors for OS.Multivariate survival analysis revealed that Involved nodal sites?3.ALC<0.6x109/L,LMR<2.5,and NR had independent prognostic significance for PFS;Male,B symptoms,LMR<2.5 and NR had independent prognostic significance for OS.This study also analyzed PET2 evaluation of 56 patients and found that PET2 positives were associated with poorer PFS,whereas the combination of PET2 with LMR was more predictive.ConclusionThe increase of monocyte count to some extent represents the abnormal increase of tumor-associated macrophages(TAM)in the tumor microenvironment.The lymphocyte count can also be regarded as the ability of the kill tumor cells by immune surveillance.The combination of the two represents changes in the tumor microenvironment and tumor immunity of lymphoma.ALC<0.6�109/L,AMC>0.7�109/L,and LMR<2.5 indicate poor prognosis in HL at initial diagnosis.LMR<2.5 is a prognostic factor for IPS-independent PFS and OS,and ALC<0.6�109/L Independent prognostic factors for PFS.ALC,AMC,LMR as a prognostic factor of HL should arouse our attention.Part twoPrognostic significance of peripheral blood monocyte count,lymphocyte count and lymphocyte to monocyte ratio in anaplastic large cell lymphomaObjectiveSystemic anaplastic large cell lymphoma(sALCL)is a relatively rare non-Hodgkin's lymphoma,tend to invade the extranodal sites,the clinical prognosis is poor.Now the International Prognost Index(IPI)score and prognostic index for T-cell lymphomas(PIT)scores coexist in clinical,and no consensus has been reached on the prognostic evaluation system.Some scholars have found that absolute monocyte count(AMC),lymphocyte absolute lymphocyte count(ALC),and lymphocyte to monocyte ratio(LMR)have prognostic significance in many malignant tumors and B cell lymphoma.However,the prognostic significance of peripheral blood AMC,ALC and LMR in T-cell lymphoma has rarely been studied.We will investigate the prognostic significance of peripheral blood AMC,ALC and LMR in sALCL patients at this article.MethodsA total of 29 newly diagnosed patients with systemic ALCL(sALCL)were selected from Jiangsu Provincial People's Hospital during the period of January 2008 to November 2015.The patient's gender,age,Ann-Arbor stage,B symptoms,Group Cooperative Oncology Group Performance Status(ECOG PS),bone marrow involvement(BMI),extranominal sites involvement(ESI),ALC,AMC,LMR,hemoglobin level(Hb),Clinical prognostic factors such as platelet count(PLT),serum lactate dehydrogenase(LDH),and ?2-microglobulin(?2-MG)levels and ALK expression at the time of initial diagnosis were recorded.The patients were followed up for survival to obtain PFS and OS data.The study find the best cut off for AMC,ALC,LMR,and compared their relationship with other prognostic factors.We performed multivariate and univariate analysis of survival for OS and PFS too.ResultsAccording to the level of each prognostic factor,it was found that the AMC in patients with ESI exceeding 1 group,elevated ?2-MG group,and non-responder(NR=SD,PD)group were significantly higher than controls.According to statistical analysis,the best cut-off value for AMC is 0.6�109/L,while the best cut-off value for LMR is 2.5.Univariate analysis showed that no response to treatment,AMC>0.6�109/L,B symptoms,physical state(PS)?2,extranodal involvement,LMR<2.5 were unfavorable prognostic factors affecting progression-free survival(PFS);no response to treatment,PS>2,high LDH level,IPI?3,PIT?2,LMR<2.5 were poor prognostic factors affecting overall survival(OS).Multivariate analysis showed that AMC>0.6�109/L and PS?2 were independent prognostic factors of PFS;no response to treatment,PS?2,and LDH above normal were independent prognostic factors affecting OS.The reason why AMC,LMR is associated with the prognosis of lymphomas is considered in view of the development of macrophages from monocytes.The increase in monocyte counts represents an abnormal increase of tumor-associated macrophages(TAM)in the tumor microenvironment.The reason is the involvement of lymphocytes in the process of tumor immunity.To a certain extent,the lymphocyte count can be regarded as a representative of the body's ability to kill tumor cells by immune surveillance.The combination of AMC and LMR represent changes in the tumor microenvironment and tumor immunity of lymphoma.ConclusionAMC>0.6�109/L and LMR<2.5 indicates a poor prognosis with sALCL.AMC level is an independent prognostic factor.AMC,LMR as a routine clinical examination items,are set of simple and easy-to-read prognostic factors of sALCL.