The derived neutrophil-to-lymphocyte ratio is an independent prognostic factor in transplantation ineligible patients with multiple myeloma

Gyeong Won Lee, Sung Woo Park, Se Il Go, Hoon Gu Kim, Min Kyoung Kim, Chang Ki Min, Jae Yong Kwak, Sang Byung Bae, Sung-Soo Yoon, Je Jung Lee, Ki Hwan Kim, Seung Hyun Nam, Yeung Chul Mun, Hyo Jung Kim, Sung Hwa Bae, Ho Jin Shin, Jung Hee Lee, Joon Seong Park, Seong Hyun Jeong, Mark Hong LeeHo Sup Lee, Keon Woo Park, Won Sik Lee, Sang Min Lee, Jeong Ok Lee, Myung Soo Hyun, Deog Yeon Jo, Sung Nam Lim, Jae Hoon Lee, Hawk Kim, Do Yeun Cho, Young Rok Do, Jeong A. Kim, Seong Kyu Park, Jin Seok Kim, Soo Jeong Kim, Hyeon Gyu Yi, Joon Ho Moon, Chul Won Choi, Sung Hyun Kim, Byung Soo Kim, Moo Rim Park, Hyeok Shim, Moo Kon Song, Youngdoe Kim, Kihyun Kim

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Background: The neutrophil-to-lymphocyte ratio (NLR) is an independent prognostic marker in solid and hematological cancers. While the derived NLR (dNLR) was shown to be non-inferior to the NLR in large cohorts of patients with different cancer types, it has not been validated as a prognostic marker for multiple myeloma (MM) to date. Methods: Between May 22, 2011 and May 29, 2014, 176 patients with MM from 38 centers who were ineligible for autologous stem cell transplantation were analyzed. The dNLR was calculated using complete blood count differential data. The optimal dNLR cut-off value according to receiver operating characteristic analysis of overall survival (OS) was 1.51. All patients were treated with melphalan and prednisone combined with bortezomib. Results: The complete response rate was lower in the high dNLR group compared to the low dNLR group (7 vs. 26.1%, respectively; p = 0.0148); the corresponding 2-year OS rates were 72.2 and 84.7%, respectively (p = 0.0354). A high dNLR was an independent poor prognostic factor for OS (hazard ratio 2.217, 95% CI 1.015-4.842; p = 0.0458). Conclusion: The dNLR is a readily available and cheaply obtained parameter in clinical studies, and shows considerable potential as a new prognostic marker for transplantation-ineligible patients with MM.

Original languageEnglish
Pages (from-to)146-156
Number of pages11
JournalActa Haematologica
Issue number3
StatePublished - 1 Oct 2018



  • Inflammatory markers
  • Lymphocytes
  • Multiple myeloma
  • Neutrophils
  • Prognostic factors

Cite this

Lee, G. W., Park, S. W., Go, S. I., Kim, H. G., Kim, M. K., Min, C. K., Kwak, J. Y., Bae, S. B., Yoon, S-S., Lee, J. J., Kim, K. H., Nam, S. H., Mun, Y. C., Kim, H. J., Bae, S. H., Shin, H. J., Lee, J. H., Park, J. S., Jeong, S. H., ... Kim, K. (2018). The derived neutrophil-to-lymphocyte ratio is an independent prognostic factor in transplantation ineligible patients with multiple myeloma. Acta Haematologica, 140(3), 146-156.