A New Prognostic Score Using Lymphocyte to Monocyte Ratio and Immunoglobulin Levels to Predict Progression in Multiple Myeloma Patients Undergoing Autologous Transplant

Abstract

Introduction Although autologous stem cell transplant (ASCT) prolongs progression free survival (PFS) in multiple myeloma (MM), prediction of outcomes is challenging due to wide variability in post-transplant survival. MM is an immune suppressive disease characterized by the development of a microenvironment that promotes disease progression and resistance to treatment. Clinical surrogates of immune suppression such as the lymphocyte to monocyte ratio (LMR) have predicted outcome in other cancers. Objectives We hypothesized that clinically available surrogates for immune suppression may predict survival after ASCT. Methods One hundred and thirty patients who underwent ASCT with melphalan 200 mg/m2 between 2002 and 2016 were included in the analysis. We collected the following values at baseline (Day -2) and Day 90 post-ASCT: absolute lymphocyte count (ALC); absolute monocyte count (AMC); lymphocyte to monocyte ratio (LMR); and the number of immunoglobulin (Ig) levels suppressed. Values were separated into upper and lower quartiles and these groups were compared for PFS. Results Baseline laboratory values did not predict PFS. However, at Day 90, a high ALC (18 versus 23 months, p=0.04) and low AMC (13 versus. 25 months, p=0.02) predicted for superior PFS. When combined, a lower LMR (defined as Conclusion We demonstrate the use of two readily available biomarkers, the lymphocyte to monocyte ratio and immunoglobulin levels, in predicting PFS in MM patients after ASCT. Independent of the infused autograft cell composition, LMR and Ig levels at day 90 could be combined into an immune score and could identify patients who will have a long duration of remission or patients with very poor prognosis who may thus benefit from more intensified post-ASCT consolidation/maintenance or use of immunotherapy.