Annals of Hematology

, Volume 94, Issue 11, pp 1875–1883 | Cite as

Neutrophil to lymphocyte ratio (NLR) improves the risk assessment of ISS staging in newly diagnosed MM patients treated upfront with novel agents

  • A. RomanoEmail author
  • N. L. Parrinello
  • M. L. Consoli
  • L. Marchionni
  • S. Forte
  • C. Conticello
  • A. Pompa
  • A. Corso
  • G. Milone
  • F. Di Raimondo
  • I. Borrello
Original Article


Recent reports identify the ratio between absolute neutrophil count (ANC) and absolute lymphocyte count (ALC), called neutrophil to lymphocyte ratio (NLR), as a predictor of progression-free survival (PFS) and overall survival (OS) in various malignancies. We retrospectively examined the NLR in a cohort of 309 newly diagnosed multiple myeloma (MM) patients treated upfront with novel agents. NLR was calculated using data obtained from the complete blood count (CBC) at diagnosis and subsequently correlated with PFS and OS. The median NLR was 1.9 (range 0.4–15.9). Higher NLR was independent of international staging system (ISS) stage, plasma cell infiltration or cytogenetics. The 5-year PFS and OS estimates were, respectively, 18.2 and 36.4 % for patients with NLR ≥ 2 versus 25.5 and 66.6 % in patients with NLR < 2. Among younger patients (age <65 years, N = 179), NLR ≥ 2 had a negative prognostic impact on both PFS and OS, in all ISS stages. By combining ISS stage and NLR in a model limited to young patients, we found that 19 % of the patients were classified as very low risk, 70 % standard risk and 11 % very high risk. The 5-year estimates were 39.3, 19.4 and 10.9 % for PFS and 95.8, 50.9 and 23.6 % for OS for very low, standard-risk and very high-risk groups. We found NLR to be a predictor of PFS and OS in MM patients treated upfront with novel agents. NLR can be combined with ISS staging system to identify patients with dismal outcome. However, larger cohorts and prospective studies are needed to use NLR as additional parameter to personalise MM therapy in the era of novel agents.


Multiple myeloma Granulocyte Lymphocyte ISS 



This work was supported in part by a grant from Ministero della Salute (Ricerca Finalizzata), by Associazione Italiana contro le Leucemie (AIL) of Catania and Fondazione Catanese per lo Studio e la Cura delle Malattie Neoplastiche del Sangue (FON.CA.NE.SA).

Conflict of interest

The authors declare that they have conflict of interest.

Supplementary material

277_2015_2462_MOESM1_ESM.doc (48 kb)
Supplementary Table 1 Characteristics at baseline of 309 newly diagnosed MM patients based on up-front treatment. Group 1, based on proteasome inhibitors alone; Group 2, based on IMiDs alone; Group 3, based on the combo proteasome inhibitor + IMiDs. (DOC 48 kb)
277_2015_2462_MOESM2_ESM.doc (51 kb)
Supplementary Table 2 Characteristics at baseline of 309 newly diagnosed MM patients split randomly 50:50 into a training and a validation set. (DOC 51 kb)
277_2015_2462_MOESM3_ESM.doc (42 kb)
Supplementary Table 3 Distribution in the training and validation set based on NLR-ISS stratification risk in the whole cohort and in patients younger than 65 years. (DOC 42 kb)
277_2015_2462_MOESM4_ESM.doc (82 kb)
Supplementary Figure 1 Progression free survival analysis based on up-front treatment. Group 1, based on proteasome inhibitors alone; Group 2, based on IMiDs alone; Group 3, based on the combo proteasome inhibitor + IMiDs. (DOC 81 kb)
277_2015_2462_MOESM5_ESM.doc (168 kb)
Supplementary Figure 2 Progression free survival and overall survival analysis based on NLR-ISS stratification risk in the training (left panels) and validation set (right panels) in the whole cohort (1-2) and in the cohort of young patients, age < 65 years (3-4). (DOC 167 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • A. Romano
    • 1
    • 2
    Email author
  • N. L. Parrinello
    • 1
  • M. L. Consoli
    • 1
  • L. Marchionni
    • 2
  • S. Forte
    • 3
  • C. Conticello
    • 1
  • A. Pompa
    • 4
  • A. Corso
    • 4
  • G. Milone
    • 1
  • F. Di Raimondo
    • 1
  • I. Borrello
    • 2
  1. 1.Division of HematologyAzienda Policlinico-Vittorio Emanuele-CataniaCataniaItaly
  2. 2.Department of OncologyJohns Hopkins UniversityBaltimoreUSA
  3. 3.IOM RicercaViagrandeItaly
  4. 4.Divisione di EmatologiaIRCCS, Fondazione San MatteoPaviaItaly

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