Prediction of survival using absolute lymphocyte count and neuthrophil/lymphocyte ratio for newly diagnosed patients with multiple myeloma

Prediction of Survival Using Absolute Lymphocyte Count and Neuthrophil/Lymphocyte Ratio For Newly Diagnosed Patients With Multiple Myeloma Purpose: Multiple Myeloma (MM), is second most common hematologic malignancy worldwide. Evaluations of prognostic factors such as Revised-International Staging System (ISS), renal functions, cytogenetic and extrameduller plasmasitoma (EMP) are important for maintenance and treatment. In our study, we review impacts of Absolute Lymphocyte Count (ALC), Absolute Neuthrophil Count (ANC), Neuthrophil/Lymphocyte Ratio (NLR) and Red Cell Distribution Width (RDW) to 5-year-survival for newly diagnosed patients with MM. Material and Method: Our study included 40 patients who was newly diagnosed Multiple Myeloma and followed by Ataturk University Medical Research Hospital Department of Internal Medicine between January 2000 to December 2010. Patients, who had extra malignancy was excluded from the study. We review baseline complete blood count (CBC) parameters (lymphocyte count, neuthrophil count and red cell distribution width) and some routine biochemistry parameters (calcium, creatinin, β-2 microglobulin, etc.). Neuthrophil Lymphocyte Ratio (NLR) was calculated using data obtained from the CBC count. Overall survival (OS) was defined as the time from diagnosis to death as a result of any cause. Statistical analyses were performed using SPSS software (Version 20.0). Parameters served numeric, percentage, median, mean and standart deviation. Kaplan and Meier (Kaplan & Meier, 1958), Log Rank test and ROC-Curve used for statistical analysis. Findings: In our study there were 27 (67.5%) males and 13 (32.5%) females. The average age of all patients was 68.4 ± 8.98 (range, 51 - 89), in male group 68.04 ± 7.87 (range, 52-83) and in female group 69.15 ± 11.27 (range, 51-89). ISS score distribution proportion was for score 1 17.5%, for score 2 %45 and for score 3 37.5%. 26 (65 %) patients died during follow-up. Five-year survival rate for all patients was 42.5%; for male patients was 40.7% and for females was 46.15%. Gender matched overall survival compared with Kaplan and Meier; analysis was significantly similar (p=0.612). Firstly, evaluation effects of age, absolute lymphocyte count (ALS), absolute neutrophil count (ANC), neutrophil-lymphocyte ratio (NLR) and erythrocyte distribution range (RDW) on survival we calculate cut-off values for each parameter with ROC Curve method. Then the cut-off values analysed with Kaplan-Meier survival analysis. Age (p= 0,042), ALC (p<0,001), ANC (p=0,001), NLR (p<0,001) and RDW (p<0,001) were statistically significant for our analysis. P <0.05 was considered statistically significant. Results: Our study showed that gender not effect overall survival; age, absolute lymphocyte count, absolute neutrophil count, neutrophil-lymphocyte ratio and erythrocyte distribution range significantly effect on overall survival. Key Words: Multiple Myeloma, Absolute Lymphocyte Count, Absolute Neuthrophil Count, Neuthrophil Lymphocyte Ratio, Red Cell Distribution Width, Average Survival