title: Comparison of prognostic impact of absolute lymphocyte count, absolute monocyte count, absolute lymphocyte count/absolute monocyte count prognostic score and ratio in patients with diffuse large B cell lymphoma.
abstract: BACKGROUND
  The combination of absolute lymphocyte count (ALC) and absolute monocyte count (AMC) at diagnosis has prognostic relevance in patients with diffuse large B cell lymphoma (DLBCL).
  
  
  OBJECTIVE
  The present study was designed to investigate the prognostic significance of ALC and AMC and to determine whether ALC/AMC ratio or ALC/AMC prognostic score is better predictor of outcome in DLBCL.
  
  
  METHODS
  We retrospectively analyzed the prognostic significance of ALC and AMC, ALC/AMC ratio and ALC/AMC prognostic score at diagnosis in 222 DLBCL patients treated with R-CHOP.
  
  
  RESULTS
  ROC analysis showed that optimal cut-off values of AMC and ALC/AMC ratio with the best sensitivity and specificity were 0.59×10(9)/L and 2.8, respectively. Cut-off of ALC was determined according to the literature data (1×10(9)/L). Low ALC, high AMC, low ALC/AMC ratio and high ALC/AMC prognostic score were in significant association with lower rate of therapy response and survival. In contrast, these parameters were not in significant correlation with relapse rate. The patients with low ALC, "high" AMC, low ALC/AMC ratio and high ALC/AMC prognostic score at diagnosis had significantly shorter EFS and OS. In multivariate analysis all tested parameters (ALC, AMC, ALC/AMC prognostic score and ALC/AMC ratio) are independent risk factors along with "bulky" disease and IPI.
  
  
  CONCLUSIONS
  All tested parameters (ALC, AMC, ALC/AMC score and ALC/AMC ratio) may be useful prognostic factors in DLBCL patients. ALC/AMC score has a slight advantage as it allows the classification of patients into three prognostic groups. Further studies are needed to determine which of these parameters has the highest predictive value.
authors.affiliation: Clinical Hospital Center "Bezanijska Kosa", Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Serbia. Electronic address: dragano@ptt.rs.
authors.forename: Olivera
authors.initials: O
authors.lastname: Markovic
authors.affiliation: Institute of Oncology, Sremska Kamenica, Serbia; Faculty of Medicine University of Novi Sad, Serbia.
authors.forename: Lazar
authors.initials: L
authors.lastname: Popovic
authors.affiliation: Clinical Hospital Center "Bezanijska Kosa", Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Serbia.
authors.forename: Dragomir
authors.initials: D
authors.lastname: Marisavljevic
authors.affiliation: Institute of Oncology, Sremska Kamenica, Serbia; Faculty of Medicine University of Novi Sad, Serbia.
authors.forename: Darjana
authors.initials: D
authors.lastname: Jovanovic
authors.affiliation: Clinical Hospital Center "Bezanijska Kosa", Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Serbia.
authors.forename: Branka
authors.initials: B
authors.lastname: Filipovic
authors.affiliation: Institute of Statistics, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Serbia.
authors.forename: Dejana
authors.initials: D
authors.lastname: Stanisavljevic
authors.affiliation: Institute of Oncology, Sremska Kamenica, Serbia; Faculty of Medicine University of Novi Sad, Serbia.
authors.forename: Gorana
authors.initials: G
authors.lastname: Matovina-Brko
authors.affiliation: Clinical Hospital Center "Bezanijska Kosa", Belgrade, Serbia.
authors.forename: Jelena
authors.initials: J
authors.lastname: Hajder
authors.affiliation: Clinical Hospital Center "Bezanijska Kosa", Belgrade, Serbia.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Matkovic
authors.affiliation: Clinical Hospital Center "Bezanijska Kosa", Belgrade, Serbia.
authors.forename: Radmila
authors.initials: R
authors.lastname: Živkovic
authors.affiliation: Clinical Hospital Center "Bezanijska Kosa", Belgrade, Serbia.
authors.forename: Natasa
authors.initials: N
authors.lastname: Stanisavljevic
authors.affiliation: Institute of Hematology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Serbia.
authors.forename: Milena
authors.initials: M
authors.lastname: Todorović
authors.affiliation: Clinical Hospital Center "Bezanijska Kosa", Belgrade, Serbia.
authors.forename: Dragana
authors.initials: D
authors.lastname: Petrovic
authors.affiliation: Institute of Hematology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Serbia.
authors.forename: Biljana
authors.initials: B
authors.lastname: Mihaljevic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D018655:Lymphocyte Count; D016403:Lymphoma, Large B-Cell, Diffuse / Q000097:blood* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009000:Monocytes; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
keywords: ALC/AMC prognostic score; ALC/AMC ratio; Absolute lymphocyte and monocyte counts; Diffuse large B cell lymphoma