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Combined immune score of lymphocyte to monocyte ratio and immunoglobulin levels predicts treatment-free survival of multiple myeloma patients after autologous stem cell transplant

Bone Marrow Transplantation volume 55, pages 199–206 (2020)Cite this article

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Abstract

Outcomes after ASCT are highly variable making it difficult to predict risk of disease progression. We analyzed the impact of clinically available immune-related biomarkers on treatment-free survival (TFS) in 130 patients receiving Mel200 and ASCT. Absolute lymphocyte count (ALC), monocyte count (AMC), neutrophil count (ANC), and immunoglobulin (Ig) levels were collected on day −2 and 90 of ASCT. The lymphocyte–monocyte (LMR) and neutrophil–lymphocyte ratios (NLR) were then derived. At Day +90, we found that low ALC (18 versus 23 months, p = 0.04) or AMC (13 versus 25 months, p = 0.02) predicted for worse TFS. A low LMR predicted for worse TFS (16 versus 52 months, p = 0.004). Patients with two or three suppressed Ig levels had worse TFS (17 versus 51 months, p = 0.04). Median TFS for poor (low LMR and 2–3 suppressed Ig), intermediate, and good (high LMR and 0–1 suppressed Ig) risk groups was 7.5 versus 27 versus 79 months, respectively (p = 0.0004). In a multivariate analysis, a low LMR and suppressed Ig levels were strong independent predictors of poor TFS. We propose an immune score combining these available tests to stratify patients at risk for early progression and identify those who may benefit from intensified post-ASCT consolidation or immunotherapy based approaches.

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Authors and Affiliations

  1. Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, USA

    Karen Sweiss

  2. Cancer Center, University of Illinois, Chicago, IL, USA

    Karen Sweiss, Nadim Mahmud, Damiano Rondelli & Pritesh R. Patel

  3. College of Medicine, University of Illinois at Chicago, Chicago, IL, USA

    Jonathan Lee

  4. Division of Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA

    Nadim Mahmud, Youngmin Park, Dolores Mahmud, Damiano Rondelli & Pritesh R. Patel

  5. Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL, USA

    Gregory S. Calip

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Correspondence to Karen Sweiss.

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Sweiss, K., Lee, J., Mahmud, N. et al. Combined immune score of lymphocyte to monocyte ratio and immunoglobulin levels predicts treatment-free survival of multiple myeloma patients after autologous stem cell transplant. Bone Marrow Transplant 55, 199–206 (2020). https://doi.org/10.1038/s41409-019-0681-3

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