Peripheral Absolute Lymphocyte Count: An Economical and Clinical Available Immune-Related Prognostic Marker for Newly Diagnosed Multiple Myeloma

BACKGROUND: To find economical and clinically available immune-related prognostic markers that could predict the overall survival (OS) of newly diagnosed multiple myeloma (NDMM) in the new drug era. MATERIAL/METHODS: Absolute lymphocyte count (ALC) and absolute monocyte count (AMC) were measured in routine blood samples from 102 patients with NDMM, and the lymphocyte-monocyte ratio (LMR) was derived. All the patients were receiving bortezomib-based chemotherapy as induction treatment. Log-rank testing was used for comparing the differences between groups. Univariate and multivariate tests were used to identify prognostic markers. RESULTS: The median ALC and LMR values at diagnosis were 1.43×10(9)/L and 3.7, respectively, and served as the cutoff point. As prognostic factors, ALC, LMR, and a new staging system combining ALC and the ISS staging system (L-ISS) were expected to have a significant impact on predicting OS. Furthermore, multivariate analysis showed that ALC ≥1.43×10(9)/L (hazard ratio [HR]: 0.223; 95% confidence interval [CI]: 0.071–0.705; P=0.011), LMR ≥3.7 (HR: 0.363; 95% CI: 0.139–0.947; P=0.038), and L-ISS late stage (HR: 1.619; 95% CI: 1.065–2.743; P=0.027) were independent predictors for OS. CONCLUSIONS: ALC and LMR can serve as surrogate markers for patients’ antitumor immunity at the initial diagnosis of multiple myeloma. A new immune-related staging system, L-ISS, which combines ALC and the ISS staging system, can predict clinical outcomes in patients who are receiving bortezomib-based chemotherapy.