Of the 189 patients, 57 (30.2%) exhibited plasmablastic disease morphology. with patient survival in MM. Multivariate analysis showed that, of these factors, the ALC/AMC ratio was an independent prognostic factor for OS. Keywords:Multiple myeloma, Lymphocytes, Monocytes, Lymphocyte/monocyte ratio, Prognosis Absolute lymphocyte count (ALC) in peripheral blood may reflect the body’s immune surveillance potential against cancer cells. Recent studies suggest that ALC, as a surrogate marker for host immune status, has prognostic significance in cancer patients. In multiple myeloma (MM), ALC recovery after autologous stem cell transplantation (ASCT) has been reported to be of significant prognostic value.1,2Furthermore, a recent study showed that ALC at the time of diagnosis was associated with survival in newly diagnosed MM patients.3 In recent years, the importance of the bone marrow (BM) microenvironment in MM has become increasingly apparent. The BM microenvironment provides a ‘niche’ that supports GNF179 growth and survival of myeloma cells, and influences their migration and drug DHCR24 resistance.4,5Among stromal cells in the microenvironment, inflammatory cells play an essential role in tumor progression.6Tumor-associated macrophages (TAMs), which GNF179 constitute a significant proportion of tumor-related inflammatory cells, have been linked to the growth, angiogenesis and metastasis of a variety of tumors. 7TAMs secrete factors that directly promote tumor cell proliferation and, by acting on endothelial cells, they also promote tumor neovascularization, which enables tumor progression.8 A prognostic role for TAMs has been reported in patients with classical Hodgkin lymphoma (HL),9,10diffuse large B-cell lymphoma (DLBCL),11follicular lymphoma (FL)12and MM.13TAMs are derived from circulating monocytes and are recruited to the tumor site by GNF179 tumor-derived chemotactic factors.14,15Since the number of circulating monocytes and the TAM content are influenced by tumor-derived chemotactic factors, the peripheral blood absolute monocyte count (AMC) may reflect the level of TAM recruitment, and therefore may have potential value as a surrogate marker for TAMs. In support of this hypothesis, AMC has recently been shown to be a reliable prognostic marker in DLBCL,16FL,17and HL.18 The power of AMC and its relationship with ALC have not been investigated in MM. The aim of this study was therefore GNF179 to analyze AMC, ALC, and the ALC/AMC ratio, as a simple marker combining an estimate of host immune status and tumor microenvironment, at the time of diagnosis in MM and to correlate the findings with clinical parameters and patient outcome. == MATERIALS AND METHODS == == Patients == This study included 189 patients who were diagnosed with MM between 2001 and 2011 at the Asan Medical Center, Seoul, Korea. Disease was considered to be plasmablastic when >30% of myeloma cells in the BM biopsy exhibited plasmablastic morphology. All patients met the following criteria: BM involvement; no previous treatment; no previous history of other malignancies, transplantation or immunosuppression; no anti-human immunodeficiency computer virus antibodies; and availability of laboratory and radiologic data and follow-up information. AMC and ALC were obtained from routine complete blood count (CBC) with a four-part differential (lymphocytes, monocytes, eosinophils, and neutrophils) using a Sysmex automated hematology analyzer (model E-4000, SE-9000 or XE-2100, Sysmex Co., Kobe, Japan), which was performed at the time of the diagnosis.19 == Statistical analysis == Overall survival (OS) was defined as the time between the date of diagnosis and the date of death from any cause. For living patients, OS was defined as the time between diagnosis and the.
Of the 189 patients, 57 (30
