Are the Derived Indexes of Peripheral Whole Blood Cell Counts (NLR, PLR, LMR/MLR) Clinically Significant Prognostic Biomarkers in Multiple Myeloma? A Systematic Review And Meta-Analysis

Xinwen Zhang; Jialin Duan; Zhenyu Wen; Hao Xiong; Xiaomin Chen; Yang Liu; Kunyu Liao; Chunlan Huang

doi:10.3389/fonc.2021.766672

Are the Derived Indexes of Peripheral Whole Blood Cell Counts (NLR, PLR, LMR/MLR) Clinically Significant Prognostic Biomarkers in Multiple Myeloma? A Systematic Review And Meta-Analysis

Front Oncol. 2021 Nov 23:11:766672. doi: 10.3389/fonc.2021.766672. eCollection 2021.

Authors

Xinwen Zhang^{1

2}, Jialin Duan^{1

2}, Zhenyu Wen³, Hao Xiong^{1

2}, Xiaomin Chen^{1

2}, Yang Liu^{1

2}, Kunyu Liao^{1

2}, Chunlan Huang^{1

2}

Affiliations

¹ Stem Cell Laboratory, Affiliated Hospital of Southwest Medical University, Luzhou, China.
² Department of Hematology, Affiliated Hospital of Southwest Medical University, Luzhou, China.
³ Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou, China.

Abstract

Background: Multiple myeloma (MM) is an incurable malignant plasma cell tumor. Whole blood cell count (WBCC) derived indexes are widely used as a predictive biomarker for various types of solid and hematological malignant tumors. Our study is to evaluate its effectiveness in MM by meta-analysis.

Methods: Relevant literatures were retrieved from PubMed, Embase and Web of Science databases according to PRISMA guideline. All relevant parameters were extracted and combined for statistical analysis.

Results: Nineteen studies incorporating 3818 MM patients were eventually included in this meta-analysis. 13 studies evaluated that elevated NLR was significantly associated with poor survival outcomes (OS: HR=2.04, P<0.001; PFS: HR=1.96, P=0.003). Elevated NLR was revealed to correlate with ISS stage (ISS III VS I-II, OR=2.23, P=0.003). A total of 7 studies have shown that elevated LMR predicts a better prognosis in MM patients (OS: HR=0.57, P<0.001; PFS: HR=0.49, P<0.05), and two other studies demonstrated that increased MLR was related to poor OS/PFS (OS: HR=1.58, P<0.05; PFS: HR=1.60, P<0.05). However, in the other 6 studies including 1560 patients, the prognostic value of PLR had not been confirmed (OS: HR=0.89, P>0.05; PFS: HR=0.87, P>0.05).

Conclusions: The indexes NLR and LMR/MLR derived from WBCC were validated to be useful biomarkers to predict the prognosis in MM patients, but the evidence of PLR was insufficient.

Keywords: lymphocyte-to-monocyte ratio (LMR); meta-analysis; monocyte-to-lymphocyte ratio (MLR); multiple myeloma (MM); neutrophil-to-lymphocyte ratio (NLR); platelet-to-lymphocyte ratio (PLR); prognosis.

Publication types

Systematic Review