Prognostic Significance of Neutrophil to Lymphocyte Ratio in Multiple Myeloma Patient

Multiple myeloma represents a hematologic malignancy characterized by the abnormal proliferation of plasma cells in the bone marrow. Through this proliferation, the malignant plasma cells disrupt normal blood cell production, subsequently causing the clinical hallmarks of this pathology: bone destruction, anemia, renal impairment and a highly increased susceptibility to infections. Despite the therapeutic options available, multiple myeloma remains an incurable disease (1). The rising use of combination therapies, triplets or quadruplets, by using immunomodulatory drugs, monoclonal antibodies and targeted therapies, elicited improved survival rates and a significant improvement of the quality of life of these patients. However, there is a luring need to precisely quantify the life horizons of these patients, therefore the most recent tool for this estimate has been developed, the R-ISS score. The R-ISS score uses various biomarkers such as serum β2-microglobulin, serum albumin, LDH levels and a more refined tool, the cytogenetic abnormalities list, to predict the outcome of each case. The addition of the precise cytogenetic risk groups boosted the sensitivity of the previous ISS score, but also unveiled the existing discrepancies in accessing modern diagnostic tools across treatment centers (2). Moreover, patient-oriented reports pointed out that from a patient perspective the highest perceived cost had been perceived until the neoplasm diagnostic was established, hence the reluctance for specialized investigations (eg. FISH testing and karyotypes etc.)