The Research Of Lymphocyte/monocyte To Lactate Dehydrogenase Ratio As An Independent Prognostic Factor For Diffuse Large B-cell Lymphoma

Objective:To investigate the prognostic value of immune response to tumor burden ratio[defined as the lymphocyte/monocyte(LMR)and lactate dehydrogenase(LDH)ratio levels]in diffuse large B-cell lymphoma(DLBCL)patients in order to provide a new prognostic indicator for the DLBCL patients.Methods:Between January 2012 and January 2018,93 patients with DLBCL who were diagnosed by pathological and immunochemical analysis,were treated at the Department of Hematology and Oncology of the Second Affiliated Hospital of Nanchang University,were retrospectively reviewed,including age,sex,the number of extranodal sites of disease,B symptoms,Eastern Cooperative Oncology Group performance status,Ann Arbor stage,the international prognostic index(IPI),Pretreatment absolute counts of lymphocytes and monocytes and lactate dehydrogenase(LDH)in peripheral blood were obtained to calculate the LMR and LMR/LDH,progression-free survival(PFS)estimated.According to the optimal cut-off of receiver operator characteristic(ROC)curve,LMR and LMR/LDH were grouped respectively.Different clinical characteristics were compared between groups.Kaplan-Meier method was used to draw the survival curve of patients.Log-rank test was used for univariate analysis.Cox regression proportional risk model was used for multivariate analysis,the correlation between clinical characteristics and PFS of patients was obtained to determine the influencing factors of prognosis of patients with DLBCL.Results:According to ROC curve related to prognosis,the cut-off values of LDH,LMR and LMR/LDH*100%were 251.81,2.83 and 2.50 respectively.There were no significant differences between LMR groups and LMR/LDH groups in gender,age,ECOG score,B symptoms,number of extranodal involved parts and treatment regimen(P>0.05),but there were significant differences in Ann Arbor stage,IPI score and LDH level(P<0.05).Kaplan Meier survival analysis showed that low LMR and low LMR/LDH level was significantly correlated with shorter PFS in either CHOP or R-CHOP treatment regimen(P<0.05).Univariate analysis showed that age,Ann Arbor stage,ECOG score,IPI score,LDH,LMR,LMR/LDH,treatment regimen were significantly correlated with PFS in DLBCL patients(P<0.05).Multivariate analysis showed that B symptom,IPI score,LMR/LDH and treatment regimen were independent factors affecting the prognosis of DLBCL patients(P<0.05).Conclusion:LMR,LDH and LMR/LDH were all related to the PFS of DLBCL patients,which can predict the prognosis of DLBCL patients.Compared with LMR and LDH,LMR/LDH had a higher predictive value and was an independent prognostic indicator for DLBCL patients.At the initial diagnosis of DLBCL,the lower the LMR/LDH level in peripheral blood,the worse the prognosis.