Efficacy And Prognosis Of The Dynamic Monitoring Peripheral Blood Lymphocyte To Monocyte Ratio In Patients With Non-hodgkin's Lymphoma

ObjectiveTo investigate the efficacy and prognosis of the dynamic monitoring peripheral blood lymphocyte to monocyte ratio in patients with non-Hodgkin's lymphoma.MethodsA total of 521 NHL patients(including 261 cases of diffuse large B-cell lymphoma,148 cases of extranodal NK/T cell lymphoma,103 cases of anaplastic large cell lymphoma)who were confirmed by pathological examination and received standardized treatment in the affiliated tumor hospital of Zhengzhou university between March 2012 to March 2019,were analyzed retrospectively.All cases were diagnosed and staged clearly according to the histopathological morphology,immunophenotype(immunohistochemistry and flow cytology),fluorescence in situ hybridization,serum lactate dehydrogenase(LDH)levels,bone marrow puncture,B-ultrasound,Computed Tomography(CT),Magnetic Resonance Imaging(MRI),or Positron Emission Computed Tomography(PET-CT)and other detection techniques.The blood routine of patients was dynamically monitored at various time points(before,during,and after treatment),the changes of lymphocyte to monocyte ratio(LMR)were calculated,and the relationship between LMR and efficacy and survival was analyzed.The optimal cut-off values of LMR was determined using the receiver operating characteristic curve(ROC)method,patients were divided into low LMR group and high LMR group according to the optimal cut-off value.In the follow-up analysis,blood routine,biochemical test and imaging(including B-ultrasound,CT,MRI,or PET-CT)were performed every 3 months in the 1st year,every 6 months in the 2nd year,and then once yearly.Morphological examination of bone marrow cells was performed in patients with bone marrow infltration at the beginning of disease.The survival time of lost patients was calculated to the last follow-up date,the follow-up deadline was July 2019.Results1.The relationship between LMR and patients with diffuse large B-cell lymphoma(DLBCL):the optimal cut-off value for LMR to predict DLBCL patients was 2.3 according to the ROC curve,and the DLBCL patients were divided into high and low LMR groups at diagnosis.It was found that the complete remission(CR)rate in the high LMR group at diagnosis(64.7%)was significantly higher than that in the low LMR group(33.3%)(P<0.001);compared with the 5-year Overall survival(OS)and Progression free survival(PFS)(56.96%and 43.55%,respectively)in the low LMR group at diagnosis,the 5-year OS and PFS(82.92%and 66.25%,respectively)in the high LMR group were significantly higher(all P value were<0.05);the OS and PFS of patients with elevated LMR after treatment were longer than those with decreased LMR after treatment(all P values were<0.05);the LMRs at relapse were significantly lower than those of at the last follow-up(all P values were<0.05).2.The relationship between LMR and patients with extranodal NK/T-cell lymphoma(ENKTL):the optimal cutoff value for LMR to predict ENKTL patients was 2.7 according to the ROC curve,and the ENKTL patients were divided into high and low LMR groups at diagnosis.The CR rate was 85.7%in patients with high LMR at diagnosis,which was remarkably higher than that of patients with low LMR at diagnosis(64.9%)(P=0.009);the 5-year OS and PFS were 49.28%and 44.89%in the low LMR group at diagnosis,respectively,5-year OS and PFS in the high LMR group were 84.50%and 67.12%,respectively,significantly longer(all P values were<0.05);the OS and PFS of patients with elevated LMR after treatment were longer than those with decreased LMR after treatment(all P values were<0.05);the OS and PFS of patients receiving chemotherapy combined with radiotherapy were significantly longer than those receiving chemotherapy alone(all P values were<0.05),there was no statistical difference in LMR after treatment between patients receiving various chemotherapy regimens,but in the high and low LMR groups,LMR after treatment in patients with chemotherapy combined with radiotherapy was higher than those of chemotherapy alone;the LMRs at relapse were significantly lower in both high and low LMR groups than those of at last follow-up(all P values were<0.05).3.The relationship between LMR and patients with anaplastic large cell lymphoma(ALCL):the optimal cutoff value for LMR to predict ALCL patients was 2.4 according to the ROC curve,and the ALCL patients were divided into high and low LMR at diagnosis.The CR rate was 80.0%in patients with high LMR at diagnosis,which was remarkably higher than that of patients with low LMR(57.1%)(P=0.019);the 5-year OS and PFS were 51.3%and 32.6%in the low LMR group at diagnosis,respectively,5-year OS and PFS in the high LMR were 90.4%and 70.5%,respectively,significantly longer(all P values were<0.05),the 5-year OS and PFS of patients in the ALK-positive group(92.8%and 76.2%,respectively)were significantly longer than those in the ALK-negative(60.4%and 47.1%,all P values were<0.05);the expression of ALK and LMR at diagnosis have a consistent prognostic effect on patients with ALCL,and the combination of ALK expression and LMR at diagnosis has a significantly better prognostic effect on patients with ALCL than alone,the patients with high LMR at diagnosis and ALK-positive had the best prognosis,while patients with low LMR at diagnosis and ALK-negative had the worst prognosis;the OS and PFS of patients with elevated LMR after treatment were longer than those with decreased LMR after treatment(all P values<0.05).Conclusion1.LMR can be used as an indicator of risk stratification,efficacy,and prognosis in patients with DLBCL,ENKTL and ALCL;and low LMR before and after treatment were poor prognostic factors.2.During the follow-up,the LMR decreased again was associate with the disease relapse in patients with DLBCL and ENKTL.