Prognostic Value Of Immune Status Changes After Chemotherapy In Patients With Newly Diagnosed Multiple Myeloma

Objective:Peripheral blood lymphocyte absolute count(ALC),monocyte absolute count(AMC)and its ratio(LMR)can be used as an indicator to reflect the immune status of MM patients.This study aimed to investigate the prognostic significance of immune changes in patients with newly diagnosed multiple myeloma(MM)after chemotherapy.Methods:The clinical data of 99 patients with multiple myeloma received treatment in Department of Hematology,Lanzhou University Second Hospital from April 2011 to December 2017 were collected and retrospectively analyzed.The change of immune status was defined by changes of lymphocyte/monocyte ratio(LMR)level.The prognosis value of age,sex,typing,hemoglobin(Hb),?2-microglobulin(?2-MG),lactate dehydrogenase(LDH),albumin(albumin,ALB)and LMR changes were investigated in patients with newly diagnosed MM,and the relationship between above mentioned factors and changes of LMR was also explored.Overall survival rate between different subgroups was compared by using Kaplan-Meier curves and detected by Log-rank tests.Univariate and multivariate analysis of prognosis was performed by using the COX proportional hazards regression model.Paired samples Wilcoxon test were used to compare changes in ALC,AMC and LMR before and after chemotherapy,and logistic regression was used to investigate the clinical factors that affect the changes of LMR.Results:The median value of ALC increased from 1.25(0.84-1.81)�10~9/L to1.39(1.02-1.9)�10~9/L(P=0.029)after treated for 1 month;the median value of AMC decreased from 0.37(0.23-0.47)�10~9/L to 0.29(0.2-0.44)�10~9/L(P=0.026),and the median value of LMR increased from 3.552(2.405-5.208)to 5.138(3.22-6.471)(P=0.002).Multivariate survival analysis showed that increasing of LMR(HR 0.459,95%CI 0.241-0.875,P=0.018)and LDH(HR 2.368,95%CI 1.123-4.995,P=0.024)were considered to be the independent factors affecting the prognosis of MM patients.Conclusion:Dynamic monitoring of ALC,AMC and LMR can not only reflect the changes of immune status of MM patients,but also predict the prognosis of MM patients much better.The increasing of LMR level after treatment indicates a better overall survival time of newly prognostic MM patients,which was an independent factor affecting the prognosis of MM patients.