Prognostic Value of the Neutrophil-to-Lymphocyte and Lymphocyte-to-Monocyte Ratios and Their Association with the International Prognostic Index in Patients with Diffuse Large B-Cell Lymphoma

Objectives: We assessed the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) at diagnosis, their correlations with the International Prognostic Index (IPI), and their impact on survival in patients with diffuse large B-cell lymphoma (DLBCL) treated with rituximab-based regimens.
Methods: We retrospectively analyzed 139 patients with DLBCL at a single center between 2008 and 2019. Optimal cutoffs were determined by ROC analysis, survival was assessed using the Kaplan–Meier method, and independent predictors were identified using Cox regression analysis.
Results: The optimal cutoffs were 2.90 for NLR and 2.40 for LMR. Both NLR≥2.90 and LMR<2.40 were associated with significantly shorter overall survival (OS) and progression-free survival (PFS) (p<0.05). NLR correlated positively with IPI (r=0.205, p=0.021), whereas LMR correlated negatively (r=−0.272, p=0.001). In multivariate analysis, ECOG performance status, serum albumin, and NLR independently predicted OS; ECOG performance status, serum albumin, and bone marrow involvement independently predicted PFS. NLR showed the highest discriminatory ability for mortality among NLR, LMR, IPI, and R-IPI.
Conclusion: NLR≥2.90 independently predicts poor OS in DLBCL and may complement existing prognostic indices as an inexpensive marker of host immunity.

Keywords: Diffuse, large B-cell, lymphocytes, lymphoma, monocytes, neutrophils, prognosis; survival analysis