Prognostic Importance of Neutrophil to Lymphocyte and Platelet to Lymphocyte Ratios in Multiple Myeloma Patients

Objectives: To evaluate the prognostic significance of baseline neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in newly diagnosed multiple myeloma (MM).
Methods: We retrospectively analyzed 327 MM patients (2012–2018) from a single tertiary center. Baseline clinical, hematologic, and biochemical data were collected. NLR and PLR were calculated. OS was estimated via Kaplan–Meier and Cox regression. ROC analysis determined an NLR cutoff.
Results: Median OS was 46.1 months; 1-, 2-, and 5-year OS rates were 77.4%, 64.5%, and 44.0%, respectively. Each one-unit increase in NLR raised the risk of death by 9.3% (HR 1.093; p=0.015). NLR correlated with poorer OS in ISS stage II, hemoglobin <10 g/dL, ≥40% bone marrow plasma cell infiltration, and calcium ≥11 mg/dL. PLR showed no association with OS (p=0.957). ROC analysis identified an NLR cutoff of 1.7 (AUC 0.584).
Conclusion: Higher baseline NLR is associated with worse survival and adverse MM features but is insufficient as a standalone marker alongside ISS/R-ISS. PLR lacks prognostic value.

Keywords: Multiple myeloma, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, prognosis