Vishal Narwani1, Joseph Gabriel1, Kevin Boyd2, Timothy Chevassut3. 1. Brighton and Sussex Medical School, Medical Research Building, University of Sussex, Brighton, United Kingdom. 2. Royal Sussex County Hospital, Eastern Road, Brighton, United Kingdom. 3. Brighton and Sussex Medical School, Medical Research Building, University of Sussex, Brighton, United Kingdom; Royal Sussex County Hospital, Eastern Road, Brighton, United Kingdom. Electronic address: t.chevassut@bsms.ac.uk.
Abstract
BACKGROUND: Survival outcomes for patients who receive treatment for newly diagnosed multiple myeloma (MM) are highly variable. PATIENTS AND METHODS: We conducted a retrospective analysis of 38 unselected MM patients who received treatment with cyclophosphamide, thalidomide, and dexamethasone to evaluate the prognostic value of the absolute lymphocyte count at diagnosis and at the end of the initial cycle of treatment defined as day 29, termed ALC-29. The median follow-up was 54 months (range, 2-83 months). RESULTS: We found that ALC-29, as a continuous variable, was a predictor of overall survival (OS) in MM patients (hazard ratio, 0.208; 95% confidence interval, 0.093-0.689; P = .007). Patients with an ALC-29 ≥ 0.8 × 10(9)/L (n = 16) experienced a superior median OS compared with patients with an ALC-29 < 0.8 × 10(9)/L (n = 22) with a median OS of 58.3 months versus 42.5 months respectively (P = .006). Multivariate analysis confirmed that ALC-29 ≥ 0.8 × 10(9)/L was an independent prognostic indicator of OS in our cohort of MM patients. CONCLUSION: We concluded that the ALC-29 is a useful and simple predictor of outcome in newly diagnosed MM patients who receive standard chemotherapy. Our results support the hypothesis that host immunity plays an important role in tumor control in MM.
BACKGROUND: Survival outcomes for patients who receive treatment for newly diagnosed multiple myeloma (MM) are highly variable. PATIENTS AND METHODS: We conducted a retrospective analysis of 38 unselected MMpatients who received treatment with cyclophosphamide, thalidomide, and dexamethasone to evaluate the prognostic value of the absolute lymphocyte count at diagnosis and at the end of the initial cycle of treatment defined as day 29, termed ALC-29. The median follow-up was 54 months (range, 2-83 months). RESULTS: We found that ALC-29, as a continuous variable, was a predictor of overall survival (OS) in MMpatients (hazard ratio, 0.208; 95% confidence interval, 0.093-0.689; P = .007). Patients with an ALC-29 ≥ 0.8 × 10(9)/L (n = 16) experienced a superior median OS compared with patients with an ALC-29 < 0.8 × 10(9)/L (n = 22) with a median OS of 58.3 months versus 42.5 months respectively (P = .006). Multivariate analysis confirmed that ALC-29 ≥ 0.8 × 10(9)/L was an independent prognostic indicator of OS in our cohort of MMpatients. CONCLUSION: We concluded that the ALC-29 is a useful and simple predictor of outcome in newly diagnosed MMpatients who receive standard chemotherapy. Our results support the hypothesis that host immunity plays an important role in tumor control in MM.
Authors: Christine M Ho; Philip L McCarthy; Paul K Wallace; Yali Zhang; Ahmad Fora; Patrick Mellors; Joseph D Tario; Benjamin L S McCarthy; George L Chen; Sarah A Holstein; Sophia R Balderman; Xuefang Cao; Bruno Paiva; Theresa Hahn Journal: Blood Adv Date: 2017-06-20