Value Of Peripheral Blood Cell Count And Its Ratio In Evaluating Prognosis Of Multiple Myeloma Patients With Initially Diagnosed Extramedullary Diseases

ObjectiveTo investigate the correlation of peripheral blood lymphocyte count(ALC),monocyte count(AMC),lymphocyte-to-monocyte ratio(LMR),platelet-lymphocyte ratio(PLR)with clinicopathological features of initially diagnosed multiple myeloma(MM)patients with non-bone-related extramedullary diseases(Usually called: strict extramedullary diseases)(strict EMD,sEMD),as well as their effect on efficacy and survival.MethodsWe retrospectively analyzed the clinicopathological data of 81 MM patients with sEMD at the initial diagnosis from January 2008 to June 2017 in Tianjin Medical University Cancer Hospital,including peripheral blood ALC,AMC,LMR,PLR,hemoglobin,creatinine level,lactate dehydrogenase level,β2 microglobulin level,therapeutic efficacy,prognosis survival and other indicators.The relationship between ALC,AMC,LMR and PLR in peripheral blood was analyzed and compared with the above clinicopathological parameters.The median of ALC,AMC,PLR and LMR were taken as the cutoff value for grouping.Kaplan-Meier method was used for univariate analysis of the relationship of ALC,AMC,PLR,LMR with survival and prognosis.The relationship of peripheral blood observational index with clinicopathological features and efficacy was analyzed by χ2 test or continuously calibrated χ2 test.The Cox proportional hazard model was used for multivariate analysis of prognosis.Results1.Efficacy analysis: There was no significant difference in the therapeutic effect between the high-value group and the low-value group of peripheral blood ALC,AMC and low-value group(P>0.05),but the therapeutic effect of PLR,LMR high-value group and low-value group patients The difference was statistically significant(P=0.032,0.030).2.Survival analysis: The 3-year survival rates of ALC in low-value group and ALC in low-value group were 35.9%(14/39)and 15.0%(6/40),respectively,and thedifference was statistically significant(P=0.033);high-value group The 3-year survival rates of AMC and low-value group AMC were 15.4%(6/39)and 35.0%(14/40),respectively,and the difference was statistically significant(P=0.045);high-value group PLR and low-value group PLR The 3-year survival rates were15.4%(6/39)and 35.0%(14/40),respectively,and the difference was statistically significant(P=0.045).The 3-year survival rates of LMR in the high-value group and LMR in the low-value group were 42.1.%(16/38),9.8%(4/41),the difference was statistically significant(P = 0.002).3.Prognostic single factor analysis: ALC≤1.38×109/L(P=0.007),AMC≥0.48×109/L(P=0.007),LMR≤3.11(P=0.001),PLR≥134.9(P=0.002),β2microglobulin ≥ 5.5 mg / L(P = 0.047),LDH ≥ 247 U / L(P = 0.012),Hb ≤ 110 g / L(P = 0.024),ISS stage(P = 0.047),the number of bone damage ≥ Three(P=0.048),bone marrow plasma cell ratio ≥ 20%(P = 0.049)was a poor prognostic factor in patients with sEMD at the time of initial diagnosis.4.Multivariate analysis of prognosis: LMR≤3.11(P=0.021),PLR≥134.9(P=0.019),LDH≥247U/L(P=0.041),Hb≤110 g/L(P=0.004)is the initial diagnosis Independent prognostic factors for poor prognosis in MM patients with sEMD.Conclusion1.The initial PLR and LMR values of MM patients with newly diagnosed EMD can be used as one of the indicators to predict the therapeutic effect.2.The initial AMC,ALC,PLR,and LMR values of MM patients with newly diagnosed EMD can be used as one of the indicators to predict their survival rate.3.ALC,AMC,LMR,PLR,β2 microglobulin level,LDH level,Hb level,ISS stage,number of bone destruction,and percentage of bone marrow plasma cells are the prognostic factors in patients with sEMD at the time of initial diagnosis.4.For patients with newly diagnosed MM with sEMD,LMR ≤ 3.11,PLR ≥134.9,LDH ≥ 247 U / L,Hb ≤ 110 g / L may be independent adverse factors affecting prognosis.