Effect of absolute lymphocyte count on progression-free and overall survival in multiple myeloma pati̇ents with autologous stem cell transplantati̇on

Multiple myeloma (MM) is not yet a curable disease despite advances in its treatment. Autologous stem cell transplantation (ASCT) with high-dose chemotherapy provides the most effective disease control in transplant-eligible patients. However, variable outcomes can be observed in terms of overall survival (OS) and progression-free survival (PFS) following ASCT. Our study aimed to investigate the effects of peripheral blood lymphocyte, monocyte, neutrophil, and platelet counts, as well as immunological and inflammatory biomarkers such as the neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), and platelet-lymphocyte ratio (PLR) on OS and PFS after ASCT in MM. We included 325 patients with MM who underwent ASCT between the years 2001 and 2022. These markers were evaluated using Kaplan-Meier survival analysis at ASCT -2, +15, and +100 days. Kaplan-Meier and multivariate Cox regression analyses were employed to assess the predictive value of absolute lymphocyte count. After ASCT, the lymphocyte count on day +15 was identified as an independent and significant prognostic factor for OS (HR, 0.656; 95% CI, 0.444-0.970; p=0.035) and PFS (HR, 0.558; 95% CI, 0.403-0.771; p<0.001). Additionally, at day -2 and +15, there was a statistically significant correlation between the monocyte count and PFS, although no statistically significant difference was observed in OS. Moreover, at day -2, +15, and +100, a statistically significant correlation was found between the platelet count and PFS, but no statistically significant difference was noted in OS. This study represents a comprehensive analysis of immunological and inflammatory indicators for predicting prognosis following ASCT in MM. Post-transplant immunological and inflammatory biomarkers can serve as noninvasive, accessible and cost-effective prognostic factors for the disease.