Objective: Acute myeloid leukemia (AML) is a heterogeneous, hematologic malignancy at which short survival may be seen. Our study aims to evaluate the effect of the neutrophil-to-lymphocyte ratio (NLR) on the course of the disease, response to therapy, and overall survival (OS). Materials and Methods: A total of 124 patients followed-up with the diagnosis of AML from 2016 to 2019 were retrospectively examined. Results: 69 of the cases (55.6%) were men and 55 (44.3%) were women. The average age at the time of diagnosis was 53.44 ± 30.3 years old. We determined the NLR as median 0.46 (0.16 - 1.1). In AML, 69 patients were responsive to the induction regimen (57.9%) while 46 patients were unresponsive (37.8%). 5 patients died before completing the regimen. D-dimer was found to be higher and fibrinogen was found to be lower in the responsive group. Lower OS was observed in cases of >60 years of age, male gender, non-APL AML, high NLR, and recurrence at diagnosis. Recurrences were detected in 23 patients (18.5%) and the median time to the recurrence was 416 (236 - 639) days. Fibrinogen level and the bone marrow blast ratio at the time of application were determined to be associated with recurrence. The median follow-up time was 856 (143 - 1276) days. Final condition analysis reveals that 74 patients (59.6%) are alive. Conclusion: We determined in our study that the NLR is effective on survival. Medical literature on this subject is scanty and prospective studies with large patient groups are needed.
References
[1]
Döhner, H., Estey, E., Grimwade, D., et al. (2017) Diagnosis and Management of AML in Adults: 2017 ELN Recommendations from an International Expert Panel. Blood, 129, 424-447. https://doi.org/10.1182/blood-2016-08-733196
[2]
Southam, C.M., Craver, L.F., Dargeon, H.W. and Burchenal, J.H. (1951) A Study of the Natural History of Acute Leukemia with Special Reference to the Duration of the Disease and the Occurrence of Remissions. Cancer, 4, 39-59. https://doi.org/10.1002/1097-0142(195101)4:1<39::AID-CNCR2820040105>3.0.CO;2-G
[3]
Sekeres, M.A., Peterson, B., Dodge, R.K., et al. (2004) Differences in Prognostic Factors and Outcomes in African Americans and Whites with Acute Myeloid Leukemia. Blood, 103, 4036-4042. https://doi.org/10.1182/blood-2003-09-3118
[4]
Olesen, L.H., Aggerholm, A., Andersen, B.L., et al. (2005) Molecular Typing of Adult Acute Myeloid Leukaemia: Significance of Translocations, Tandem Duplications, Methylation, and Selective Gene Expression Profiling. British Journal of Haematology, 131, 457-467. https://doi.org/10.1111/j.1365-2141.2005.05791.x
Smith, M., Barnett, M., Bassan, R., et al. (2004) Adult Acute Myeloid Leukaemia. Critical Reviews in Oncology/Hematology, 50, 197-222. https://doi.org/10.1016/j.critrevonc.2003.11.002
[7]
Faderl, S. and Kantarjian, H.M. (2013) Clinical Manifestations and Treatment of Acute Myeloid Leukemia. In: Hoffman, R., Benz Jr., E.J., Silberstein, L.E., Heslop, H.E., Weitz, J.I. and Anastasi, J., Eds., Hematology: Basic Principles and Practice, 6th Edition, Elsevier Saunders, Philadelphia.
[8]
Russell, C.D., Parajuli, A., Gale, H.J., et al. (2019) The Utility of Peripheral Blood Leucocyte Ratios as Biomarkers in Infectious Diseases: A Systematic Review and Meta-Analysis. Journal of Infection, 78, 339-348. https://doi.org/10.1016/j.jinf.2019.02.006
[9]
Sarikaya, M., Dogan, Z., Ergul, B. and Filik, L. (2014) Neutrophil-to-Lymphocyte Ratio as a Sensitive Marker in Diagnosis of Celiac Disease. Annals of Gastroenterology, 7, 431-432.
[10]
Hajibandeh, S., Hajibandeh, S., Hobbs, N. and Mansour, M. (2020) Neutrophil-to-Lymphocyte Ratio Predicts Acute Appendicitis and Distinguishes between Complicated and Uncomplicated Appendicitis: A Systematic Review and Meta-Analysis. The American Journal of Surgery, 219, 154-163. https://doi.org/10.1016/j.amjsurg.2019.04.018
[11]
Vulliamy, P., McCluney, S., Mukherjee, S., Ashby, L. and Amalesh, T. (2016) Postoperative Elevation of the Neutrophil: Lymphocyte Ratio Predicts Complications Following Esophageal Resection. World Journal of Surgery, 40, 1397-1403. https://doi.org/10.1007/s00268-016-3427-z
[12]
Gibson, P.H., Croal, B.L., Cuthbertson, B.H., et al. (2007) Preoperative Neutrophil-Lymphocyte Ratio and Outcome from Coronary Artery Bypass Grafting. American Heart Journal, 154, 995-1002. https://doi.org/10.1016/j.ahj.2007.06.043
[13]
Dong, C.-H., Wang, Z.-M. and Chen, S.-Y. (2018) Neutrophil to Lymphocyte Ratio Predict Mortality and Major Adverse Cardiac Events in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis. Clinical Biochemistry, 52, 131-136. https://doi.org/10.1016/j.clinbiochem.2017.11.008
[14]
Sun, J., Chen, X., Gao, P., et al. (2016) Can the Neutrophil to Lymphocyte Ratio Be Used to Determine Gastric Cancer Treatment Outcomes? A Systematic Review and Meta-Analysis. Disease Markers, 2016, Article ID: 7862469. https://doi.org/10.1155/2016/7862469
[15]
Ethier, J.-L., Desautels, D., Templeton, A., Shah, P.S. and Amir, E. (2017) Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Breast Cancer: A Systematic Review and Meta-Analysis. Breast Cancer Research, 19, Article No. 2. https://doi.org/10.1186/s13058-016-0794-1
[16]
Romano, A., Parrinello, N.L., Vetro, C., et al. (2018) Prognostic Meaning of Neutrophil to Lymphocyte Ratio (NLR) and Lymphocyte to Monocyte Ration (LMR) in Newly Diagnosed Hodgkin Lymphoma Patients Treated Upfront with a PET-2 Based Strategy. Annals of Hematology, 97, 1009-1018. https://doi.org/10.1007/s00277-018-3276-y
[17]
Zeng, Q., Liu, Z., Li, Q. and Liu, T. (2018) Prognostic Value of Neutrophil to Lymphocyte Ratio and Clinicopathological Characteristics for Multiple Myeloma: A Meta-Analysis. Medicine, 97, e12678. https://doi.org/10.1097/MD.0000000000012678
[18]
Appelbaum, F.R., Gundacker, H., Head, D.R., et al. (2006) Age and Acute Myeloid Leukemia. Blood, 107, 3481-3485. https://doi.org/10.1182/blood-2005-09-3724
[19]
Byrne, M.M., Halman, L.J., Koniaris, L.G., et al. (2011) Effects of Poverty and Race on Outcomes in Acute Myeloid Leukemia. American Journal of Clinical Oncology, 34, 297-304. https://doi.org/10.1097/COC.0b013e3181dea934
[20]
Matasar, M.J., Ritchie, E.K., Consedine, N., Magai, C. and Neugut, A.I. (2006) Incidence Rates of the Major Leukemia Subtypes among U.S. Hispanics, Blacks, and Non-Hispanic Whites. Leukemia & Lymphoma, 47, 2365-2370. https://doi.org/10.1080/10428190600799888
[21]
American Cancer Society (2020) Cancer Facts and Figures 2020. ACS Website. https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2020.html
[22]
Gangatharan, S.A., Grove, C.S., P’ng, S., et al. (2013) Acute Myeloid Leukaemia in Western Australia 1991-2005: A Retrospective Population-Based Study of 898 Patients Regarding Epidemiology, Cytogenetics, Treatment and Outcome. Internal Medicine Journal, 43, 903-911. https://doi.org/10.1111/imj.12169
[23]
Leith, C.P., Kopecky, K.J., Godwin, J., et al. (1997) Acute Myeloid Leukemia in the Elderly: Assessment of Multidrug Resistance (MDR1) and Cytogenetics Distinguishes Biologic Subgroups with Remarkably Distinct Responses to Standard Chemotherapy. A Southwest Oncology Group Study. Blood, 89, 3323-3329. https://doi.org/10.1182/blood.V89.9.3323
[24]
Manoharan, A., Baker, R.I. and Kyle, P.W. (1997) Low-Dose Combination Chemotherapy for Acute Myeloid Leukemia in Elderly Patients: A Novel Approach. American Journal of Hematology, 55, 115-117. https://doi.org/10.1002/(SICI)1096-8652(199706)55:2<115::AID-AJH12>3.0.CO;2-D
[25]
Wahlin, A., Markevärn, B., Golovleva, I. and Nilsson, M. (2001) Prognostic Significance of Risk Group Stratification in Elderly Patients with Acute Myeloid Leukaemia. British Journal of Haematology, 115, 25-33. https://doi.org/10.1046/j.1365-2141.2001.03043.x
[26]
Letendre, L., Noel, P., Litzow, M.R., Hoagland, H.C. and Tefferi, A. (1998) Treatment of Acute Myelogenous Leukemia in the Older Patient with Attenuated High-Dose Ara-C. American Journal of Clinical Oncology, 21, 142-144. https://doi.org/10.1097/00000421-199804000-00009
[27]
Bello, C., Yu, D., Komrokji, R.S., et al. (2011) Outcomes after Induction Chemotherapy in Patients with Acute Myeloid Leukemia Arising from Myelodysplastic Syndrome. Cancer, 117, 1463-1469. https://doi.org/10.1002/cncr.25598
[28]
National Comprehensive Cancer Network (2019) NCCN Clinical Practice Guidelines in Oncology: Acute Myeloid Leukemia. Version 3.2020. NCCN Website. http://www.nccn.org/
[29]
Tamamyan, G., Kadia, T., Ravandi, F., et al. (2017) Frontline Treatment of Acute Myeloid Leukemia in Adults. Critical Reviews in Oncology/Hematology, 110, 20-34. https://doi.org/10.1016/j.critrevonc.2016.12.004
[30]
Bertoli, S., Bérard, E., Huguet, F., et al. (2013) Time from Diagnosis to Intensive Chemotherapy Initiation Does Not Adversely Impact the Outcome of Patients with Acute Myeloid Leukemia. Blood, 121, 2618-2626. https://doi.org/10.1182/blood-2012-09-454553
[31]
Chen, C.-C., Yang, C.-F., Yang, M.-H., et al. (2005) Pretreatment Prognostic Factors and Treatment Outcome in Elderly Patients with de Novo Acute Myeloid Leukemia. Annals of Oncology, 16, 1366-1373. https://doi.org/10.1093/annonc/mdi259
[32]
Arber, D.A., Stein, A.S., Carter, N.H., et al. (2003) Prognostic Impact of Acute Myeloid Leukemia Classification: Importance of Detection of Recurring Cytogenetic Abnormalities and Multilineage Dysplasia on Survival. American Journal of Clinical Pathology, 119, 672-680. https://doi.org/10.1309/EM7KCQR4GLMHRCX4
[33]
Teke, H.U., Davutoglu, N.O., Gunduz, E., et al. (2017) Prognostic Factors, Survival Analysis and Cytogenetic Outcomes in Adult Patients with Acute Myeloid Leukemia: A Single Center Results. International Journal of Hematology & Oncology, 27, 150-160. https://doi.org/10.4999/uhod.171919
[34]
Stefaniuk, P., Szymczyk, A. and Podhorecka, M. (2020) The Neutrophil to Lymphocyte and Lymphocyte to Monocyte Ratios as New Prognostic Factors in Hematological Malignancies—A Narrative Review. Cancer Management and Research, 12, 2961-2977. https://doi.org/10.2147/CMAR.S245928
[35]
Mushtaq, M.U., Chaudhary, S.G., Murthy, G.S.G., et al. (2018) Prognostic Significance of Neutrophil-to-Lymphocyte Ratio in Relapsed/Refractory Acute Myeloid Leukemia. Blood, 132, 5246. https://doi.org/10.1182/blood-2018-99-112204
