Independent prognostic value of the lymphocyte-to-monocyte ratio in multiple myeloma patients after adjustment for the R-ISS and the second R-ISS

Abstract Objectives The lymphocyte-to-monocyte ratio (LMR) is an inflammatory biomarker that reflects immune dysregulation associated with the growth and survival of multiple myeloma (MM) cells. This study aimed to determine the prognostic significance of LMR in patients with MM after adjustment for the Revised International Staging System (R-ISS) and the Second R-ISS (R2-ISS). Methods There were 117 patients with newly diagnosed MM that were enrolled in an ambidirectional cohort study. Pre-treatment LMR values were obtained before the initiation of chemotherapy. Patients received chemotherapy and were followed to evaluate overall survival (OS) and progression-free survival (PFS). Receiver operating characteristic curve analysis identified an optimal LMR cutoff value of 3.0 for predicting survival outcomes. Results LMR was inversely associated with creatinine, β 2 M levels, ISS, and R2-ISS stages. An LMR ≤3.0 was associated with a poor response to chemotherapy. Patients with an LMR ≤3.0 had significantly shorter OS and PFS than those with an LMR>3.0 (median OS: 20.0 vs. 28.7 months, p=0.005; median PFS: 18.1 vs. 25.0 months, p=0.035). Multivariable Cox proportional hazards analysis, adjusted for R-ISS or R2-ISS, demonstrated that an LMR ≤3.0 was independently associated with OS but not PFS. Conclusions The LMR appears to be an independent predictor of OS in patients with MM. However, its prognostic value for PFS remains inconclusive.