title: Peripheral blood lymphocyte/monocyte ratio predicts outcome in follicular lymphoma and in diffuse large B-cell lymphoma patients in the rituximab era.
abstract: BACKGROUND
  Diffuse large B-cell lymphoma is an aggressive lymphoma and a large number of studies have therefore focused on the search for prognostic factors. The same interest concerns FL, for which identification of patients candidates for watch and wait (W&W) strategy is still an option. Studies about the number and type of lymphocytes and monocytes detectable in patients with Hodgkin and non-Hodgkin lymphomas indicate they might affect the pathogenesis and prognosis of these diseases. LMR is recently under investigation as a new prognostic parameter in DLBCL; the role of this ratio in FL in the rituximab era is unknown.
  
  
  METHODS
  We retrospectively analyzed 137 DLBCL and 132 FL patients referred to our institution; among FL pts, a W&W approach was performed at diagnosis for 42 patients. The remaining patients were treated with rituximab-containing therapy. We analyzed different LMR cutoff values at diagnosis and we wanted to investigate the prognostic effect among DLBCL and FL.
  
  
  RESULTS
  We found that the most discriminative LMR was 2.4 for DLBCL and 2 for FL. Among DLBCL patients, an LMR value < 2.4 was associated with a worse 2-year progression-free survival (PFS), and we observed no difference in overall survival and complete response rate. Considering FL patients, LMR > 2 was associated with a longer time to treatment start compared with the LMR < 2 group (P = .0096). Among the 92 patients treated with rituximab chemotherapy, 2-year PFS was superior in the LMR > 2 group.
  
  
  CONCLUSIONS
  LMR at diagnosis is a simple tool to better define long-term outcome of DLBCL and FL patients. The use of this tool might better define selection in FL of ideal candidates for W&W strategy.
authors.affiliation: Division of Hematology, Ospedale San Gerardo - Università degli Studi Milano Bicocca, Monza, Italy. Electronic address: ange.belotti@gmail.com.
authors.forename: Angelo
authors.initials: A
authors.lastname: Belotti
authors.affiliation: Division of Hematology, Ospedale San Gerardo - Università degli Studi Milano Bicocca, Monza, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Doni
authors.affiliation: Division of Hematology, Ospedale San Gerardo - Università degli Studi Milano Bicocca, Monza, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Bolis
authors.affiliation: Division of Hematology, Ospedale San Gerardo - Università degli Studi Milano Bicocca, Monza, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Rossini
authors.affiliation: Division of Hematology, Ospedale San Gerardo - Università degli Studi Milano Bicocca, Monza, Italy.
authors.forename: Ivana
authors.initials: I
authors.lastname: Casaroli
authors.affiliation: Division of Hematology, Ospedale San Gerardo - Università degli Studi Milano Bicocca, Monza, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Pezzatti
authors.affiliation: Division of Hematology, Ospedale San Gerardo - Università degli Studi Milano Bicocca, Monza, Italy.
authors.forename: Enrico Maria
authors.initials: EM
authors.lastname: Pogliani
authors.affiliation: Division of Hematology, Ospedale San Gerardo - Università degli Studi Milano Bicocca, Monza, Italy.
authors.forename: Pietro Enrico
authors.initials: PE
authors.lastname: Pioltelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008214:Lymphocytes; D008224:Lymphoma, Follicular / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D016403:Lymphoma, Large B-Cell, Diffuse / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009000:Monocytes; D009367:Neoplasm Staging; D011241:Prednisone / Q000627:therapeutic use; D011379:Prognosis; D012189:Retrospective Studies; D000069283:Rituximab / Q000627:therapeutic use*; D016019:Survival Analysis; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: Outside of a clinical trial; Prognosis; Tumor burden; Tumor microenvironment; Watch and wait