title: Peripheral blood absolute lymphocyte/monocyte ratio as a useful prognostic factor in diffuse large B-cell lymphoma in the rituximab era.
abstract: OBJECTIVE
  The tumor microenvironment, including tumor-infiltrating lymphocytes and myeloid-derived cells, is an important factor in the pathogenesis and clinical behavior of malignant lymphoma. However, the prognostic significance of peripheral lymphocytes and monocytes in lymphoma remains unclear.
  
  
  METHODS
  We evaluated the prognostic impact of the absolute lymphocyte count (ALC), absolute monocyte count (AMC), and lymphocyte/monocyte ratio (LMR) in 359 diffuse large B-cell lymphoma (DLBCL) patients treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP).
  
  
  RESULTS
  The median follow-up time of the surviving patients was 58 months. Low ALC and an elevated AMC were both associated with poor survival rates. Receiver operating characteristic curve analysis showed that LMR was the best predictor of survival, with 4.0 as the cutoff point. Patients with LMR ≤4.0 were more likely to have an aggressive tumor, and this was associated with poor treatment responses. Patients with LMR ≤4.0 at diagnosis had significantly poorer overall survival (OS) and progression-free survival (PFS) than those with LMR >4.0. Multivariate analysis, which included prognostic factors of the International Prognostic Index, showed LMR ≤4.0 to be an independent predictor for the OS (hazard ratio [HR], 2.507; 95% confidence interval [CI], 1.255-5.007; P = 0.009) and PFS (HR, 2.063; 95% CI, 1.249-3.408; P = 0.005).
  
  
  CONCLUSIONS
  The LMR at diagnosis, as a simple index which reflects host systemic immunity, predicts clinical outcomes in DLBCL patients treated with R-CHOP.
authors.affiliation: Department of Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan; Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: Reina
authors.initials: R
authors.lastname: Watanabe
authors.forename: Naoto
authors.initials: N
authors.lastname: Tomita
authors.forename: Megumi
authors.initials: M
authors.lastname: Itabashi
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ishibashi
authors.forename: Eri
authors.initials: E
authors.lastname: Yamamoto
authors.forename: Satoshi
authors.initials: S
authors.lastname: Koyama
authors.forename: Kazuho
authors.initials: K
authors.lastname: Miyashita
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takahashi
authors.forename: Yuki
authors.initials: Y
authors.lastname: Nakajima
authors.forename: Yukako
authors.initials: Y
authors.lastname: Hattori
authors.forename: Kenji
authors.initials: K
authors.lastname: Motohashi
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Takasaki
authors.forename: Rika
authors.initials: R
authors.lastname: Ohshima
authors.forename: Chizuko
authors.initials: C
authors.lastname: Hashimoto
authors.forename: Etsuko
authors.initials: E
authors.lastname: Yamazaki
authors.forename: Katsumichi
authors.initials: K
authors.lastname: Fujimaki
authors.forename: Rika
authors.initials: R
authors.lastname: Sakai
authors.forename: Shin
authors.initials: S
authors.lastname: Fujisawa
authors.forename: Shigeki
authors.initials: S
authors.lastname: Motomura
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ishigatsubo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000627:therapeutic use; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000166:cytology*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000166:cytology*; D011241:Prednisone / Q000627:therapeutic use; D011379:Prognosis; D012372:ROC Curve; D000069283:Rituximab; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: diffuse large B-cell lymphoma; lymphocyte; monocyte; prognosis