Prognostic Significance of Peripheral Blood Neutrophil‐To‐Lymphocyte Ratio (
NLR
), Monocyte‐To‐Lymphocyte Ratio (
MLR
), and Platelet‐To‐Lymphocyte
Lihong Zhang, Bing Ma, Jingyu Zhang ABSTRACT
Background
The tumor microenvironment drives pathogenesis and drug resistance in multiple myeloma (MM), while the R‐ISS does not capture host immune status. We investigated whether simple systemic inflammation markers—neutrophil‐to‐lymphocyte ratio, monocyte‐to‐lymphocyte ratio, and platelet‐to‐lymphocyte ratio—could improve prognostic assessment and identify high‐risk patients among newly diagnosed MM patients treated with novel agents in a retrospective cohort.
Methods
We conducted a single‐center retrospective analysis of 268 newly diagnosed MM patients between January 2019 and December 2023. Optimal cut‐off values were determined using Receiver Operating Characteristic (ROC) curve analysis. The primary endpoints were Overall Survival (OS) and Progression‐Free Survival (PFS).
Results
The optimal cut‐off values were determined as 2.85 for NLR, 0.34 for MLR, and 142.5 for PLR. Elevated NLR and MLR were significantly correlated with advanced R‐ISS stage (III), anemia, and high beta‐2 microglobulin ( p < 0.01). Kaplan–Meier analysis showed that patients with high NLR and MLR had significantly inferior OS and PFS. In the multivariate Cox regression model adjusted for cytogenetic risk and post‐induction ASCT, high NLR (HR = 1.84, 95% CI: 1.22–2.78, p = 0.004) and high MLR (HR = 1.65, 95% CI: 1.10–2.48, p = 0.015) remained independent prognostic factors. PLR was not significant in multivariate analysis.
Conclusion
Pretreatment NLR and MLR are robust, cost‐effective prognostic biomarkers in MM that retain their independent predictive value even after adjusting for the R‐ISS and intensive post‐induction therapies such as ASCT. They reflect the immunosuppressive TME and may significantly refine the current staging system to identify high‐risk patients who might require earlier immune‐bridging interventions.