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Day 15 Peripheral Blood Lymphocyte/monocyte Ratio Post-autologous Peripheral Hematopoietic Stem Cell Transplantation and Survival in Diffuse Large B-cell Lymphoma

Luis F. Porrata, David J. Inwards, Stephen M. Ansell, Ivana N. Micallef, Patrick B. Johnston, William J. Hogan and Svetomir N. Markovic

Day 15 absolute lymphocyte count (ALC-15) post-autologous peripheral hematopoietic stem cell transplantation (APHSCT) is a prognostic factor for survival. Monocyte-derived cells affect tumor growth by suppression of host antitumor immunity and promotion of tumor angiogenesis (tumor microenvironment). Thus, we set out to investigate if the absolute lymphocyte count/ absolute monocyte count ratio at day 15 (ALC/AMC-15 ratio), as a biomarker of host immunity and tumor microenvironment, affects survival post-APHSCT. From 1994 to 2007, 256 diffuse large B-cell lymphoma (DLBCL) patients that underwent APHSCT were studied. The median follow-up for the cohort was 2.8 years (range: 0.1-17 years). Patients with an ALC/AMC-15 =1 experienced a superior overall survival (OS) versus patients with an ALC/AMC-15 < 1 post-APHSCT (median OS was not reached vs 9.9 months, 5-year OS rates of 86% vs 16%, p < 0.0001, respectively). Progression-free survival (PFS) was also superior if the ALC/AMC-15 ratio was = 1 vs < 1 (median PFS was 197 vs 4.4 months, 5-year PFS rates of 83% vs 10%, p < 0.0001, respectively). Multivariate analysis showed ALC/AMC-15 ratio to be an independent prognostic factor for OS and PFS post- APHSCT. ALC/AMC-15 ratio is associated with clinical outcomes post-APHSCT in DLBCL patients and warrants further studies.