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Pre-treatment neutrophil to lymphocyte ratio as a biomarker of frailty and predictor of survival among older adults with multiple myeloma

  • Author Footnotes
    1 contributed equally as co-first authors.
    Smith Giri
    Correspondence
    Corresponding author at: Institute for Cancer Outcomes and Survivorship, Division of Hematology-Oncology, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder 500, Birmingham, AL 35294, United States.
    Footnotes
    1 contributed equally as co-first authors.
    Affiliations
    Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, United States

    Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
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  • Author Footnotes
    1 contributed equally as co-first authors.
    Sumit Dahal
    Footnotes
    1 contributed equally as co-first authors.
    Affiliations
    Department of Hospital Medicine, St. Joseph Hospital, Bangor, ME, United States
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  • Susan Bal
    Affiliations
    Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
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  • Kelly N. Godby
    Affiliations
    Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
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  • Joshua Richman
    Affiliations
    Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, United States
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  • Adam J. Olszewski
    Affiliations
    Division of Hematology-Oncology, Lifespan Cancer Institute, Providence, RI, United States
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  • Grant R. Williams
    Affiliations
    Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, United States

    Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
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  • Cynthia Brown
    Affiliations
    Division of Gerontology, Geriatrics & Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
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  • Thomas W. Buford
    Affiliations
    Division of Gerontology, Geriatrics & Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
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  • Luciano J. Costa
    Affiliations
    Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
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  • Smita Bhatia
    Affiliations
    Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, United States
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  • Author Footnotes
    1 contributed equally as co-first authors.
Published:December 17, 2021DOI:https://doi.org/10.1016/j.jgo.2021.12.004

      Abstract

      Introduction

      Neutrophil to Lymphocyte Ratio (NLR) combines a marker of inflammation and reduced cell turnover to reflect age related alterations in the immune system. Whether NLR can serve as a biomarker of frailty and predict survival among older adults with Multiple Myeloma (MM) is unknown.

      Materials and methods

      We used an electronic health record-derived database to identify older adults (age ≥ 60y) with incident MM diagnosed between 1/2011 and 2/2020, with known pre-treatment absolute neutrophil and lymphocyte count up to 90 days before the start of therapy. The calculated NLR values were stratified into quartiles (Q1-Q4). We constructed a previously validated, simplified frailty index combining age, comorbidity and ECOG performance status. We measured the association between NLR quartiles and this frailty index using a logistic regression, adjusted for age, sex and race/ethnicity. We used Kaplan Meier methods and multivariable Cox regression to assess the impact of NLR on overall survival adjusting for potential confounders.

      Results

      We identified 1729 older adults with newly diagnosed MM, at a median age of 73y (IQR: 67-78y). The median NLR was 2.13 (IQR: 1.44 to 3.31). Of the 1135 evaluable patients, 55% met criteria for frailty. Multivariable analysis revealed a 2.1-fold higher odds of frailty (95%CI = 1.42–3.10, p < 0.001) for patients in the NLR Q4 group vs. NLR Q1 group. In a multivariable analysis, adjusting for age, sex, race/ethnicity, M-protein type, stage, high risk cytogenetics, baseline creatinine, LDH and type of first line therapy, patients in NLR Q4 group had a 1.51 times increased hazards of death (95%CI = 1.15–1.98, p 0.002) when compared to those in NLR Q1 group.

      Conclusion

      NLR, a readily available laboratory biomarker, is associated with frailty measured using a simplified frailty index as well as inferior overall survival among older adults with MM. Future studies should explore its value as a screening tool to identify frail older adults with MM.

      Keywords

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