title: Absolute lymphocyte count at day 29 of treatment is a powerful predictor of outcome in multiple myeloma.
abstract: BACKGROUND
  Survival outcomes for patients who receive treatment for newly diagnosed multiple myeloma (MM) are highly variable.
  
  
  METHODS
  We conducted a retrospective analysis of 38 unselected MM patients who received treatment with cyclophosphamide, thalidomide, and dexamethasone to evaluate the prognostic value of the absolute lymphocyte count at diagnosis and at the end of the initial cycle of treatment defined as day 29, termed ALC-29. The median follow-up was 54 months (range, 2-83 months).
  
  
  RESULTS
  We found that ALC-29, as a continuous variable, was a predictor of overall survival (OS) in MM patients (hazard ratio, 0.208; 95% confidence interval, 0.093-0.689; P = .007). Patients with an ALC-29 ≥ 0.8 × 10(9)/L (n = 16) experienced a superior median OS compared with patients with an ALC-29 < 0.8 × 10(9)/L (n = 22) with a median OS of 58.3 months versus 42.5 months respectively (P = .006). Multivariate analysis confirmed that ALC-29 ≥ 0.8 × 10(9)/L was an independent prognostic indicator of OS in our cohort of MM patients.
  
  
  CONCLUSIONS
  We concluded that the ALC-29 is a useful and simple predictor of outcome in newly diagnosed MM patients who receive standard chemotherapy. Our results support the hypothesis that host immunity plays an important role in tumor control in MM.
authors.affiliation: Brighton and Sussex Medical School, Medical Research Building, University of Sussex, Brighton, United Kingdom.
authors.forename: Vishal
authors.initials: V
authors.lastname: Narwani
authors.affiliation: Brighton and Sussex Medical School, Medical Research Building, University of Sussex, Brighton, United Kingdom.
authors.forename: Joseph
authors.initials: J
authors.lastname: Gabriel
authors.affiliation: Royal Sussex County Hospital, Eastern Road, Brighton, United Kingdom.
authors.forename: Kevin
authors.initials: K
authors.lastname: Boyd
authors.affiliation: Brighton and Sussex Medical School, Medical Research Building, University of Sussex, Brighton, United Kingdom; Royal Sussex County Hospital, Eastern Road, Brighton, United Kingdom. Electronic address: t.chevassut@bsms.ac.uk.
authors.forename: Timothy
authors.initials: T
authors.lastname: Chevassut
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: ALC; ALC-29; Cyclophosphamide Thalidomide Dexamethasone; Prognosis; Survival