Fig. 1Kaplan-Meier curves of overall survival in multiple myeloma patients according to absolute lymphocyte count (ALC) (A), absolute monocyte count (AMC) (B), and the ALC/AMC ratio (C).
Fig. 2Kaplan-Meier curves of overall survival in multiple myeloma patients with (A-C) or without (D-F) autologous stem cell transplantation, according to absolute lymphocyte count (ALC) (A, D), absolute monocyte count (AMC) (B, E), and the ALC/AMC ratio (C, F).
Table 1.Characteristics of multiple myeloma patients according to ALC, AMC, and the ALC/AMC ratio
Characteristic |
ALC < 1,400 cells/µL |
ALC ≥ 1,400 cells/µL |
p-value |
AMC < 490 cells/µL |
AMC ≥ 490 cells/µL |
p-value |
ALC/AMC < 2.9 |
ALC/AMC ≥ 2.9 |
p-value |
Age |
60 (31-81) |
60 (29-84) |
.939a
|
60 (29-81) |
60 (31-84) |
.934a
|
62 (31-84) |
59 (29-81) |
.130a
|
Sex |
|
|
.459b
|
|
|
< .0001b
|
|
|
.011b
|
Male |
41 (41.8) |
57 (58.2) |
|
55 (56.1) |
43 (43.9) |
|
36 (36.7) |
62 (63.3) |
|
Female |
33 (36.3) |
58 (63.7) |
|
77 (84.6) |
14 (15.4) |
|
18 (19.8) |
73 (80.2) |
|
International Staging System (ISS) |
|
|
.004c
|
|
|
.195c
|
|
|
.142c
|
I |
8 (22.9) |
27 (77.1) |
|
27 (77.1) |
8 (22.9) |
|
7 (20.0) |
28 (80.0) |
|
II |
29 (33.3) |
58 (66.7) |
|
62 (71.3) |
25 (28.7) |
|
23 (26.4) |
64 (73.6) |
|
III |
33 (54.1) |
28 (45.9) |
|
37 (60.7) |
24 (39.3) |
|
23 (37.7) |
38 (62.3) |
|
Durie-Salmon stage |
|
|
.745c
|
|
|
.641c
|
|
|
.263c
|
I |
6 (28.6) |
15 (71.4) |
|
15 (71.4) |
6 (28.6) |
|
8 (38.1) |
13 (61.9) |
|
II |
22 (42.3) |
30 (57.7) |
|
37 (71.2) |
15 (28.8) |
|
12 (23.1) |
40 (76.9) |
|
IIIA |
35 (39.3) |
54 (60.7) |
|
64 (71.9) |
25 (28.1) |
|
23 (25.8) |
66 (74.2) |
|
IIIB |
11 (40.7) |
16 (59.3) |
|
16 (59.3) |
11 (40.7) |
|
11 (40.7) |
16 (59.3) |
|
Morphology |
|
|
.027b
|
|
|
.112b
|
|
|
.008b
|
Plasmablastic |
29 (50.9) |
28 (49.1) |
|
33 (57.9) |
24 (42.1) |
|
26 (45.6) |
31 (54.4) |
|
Plasmacytic |
32 (32.3) |
67 (67.7) |
|
71 (71.7) |
28 (28.3) |
|
24 (24.2) |
75 (75.8) |
|
Bone lesion |
|
|
.233b
|
|
|
1.000b
|
|
|
.873b
|
≥ 3 lytic bone lesions |
42 (43.8) |
54 (56.3) |
|
67 (69.8) |
29 (30.2) |
|
28 (29.2) |
68 (70.8) |
|
< 3 lytic bone lesions |
32 (34.4) |
61 (65.6) |
|
65 (69.9) |
28 (30.1) |
|
26 (28.0) |
67 (72.0) |
|
β2m (mg/L) |
8.98 (0.89-82.50) |
7.80 (1.40-65.80) |
.122a
|
6.47 (0.89-48.40) |
12.20 (1.60-82.50) |
.015a
|
10.96 (0.89-82.50) |
7.14 (1.00-63.80) |
.087a
|
Albumin (g/dL) |
3.00 (0.90-10.70) |
3.22 (1.10-4.60) |
.004a
|
3.12 (0.90-10.70) |
3.17 (0.90-4.60) |
.316a
|
2.99 (0.90-4.50) |
3.19 (0.90-10.70) |
.265a
|
Cr (mg/dL) |
1.70 (0.50-14.40) |
1.75 (0.39-18.70) |
.976a
|
1.50 (0.50-14.40) |
2.27 (0.39-18.70) |
.014a
|
2.22 (0.39-18.70) |
1.53 (0.50-8.50) |
.282a
|
Hb (g/dL) |
9.81 (6.40-14.80) |
10.68 (5.50-15.40) |
.005a
|
10.17 (5.50-15.40) |
10.74 (6.30-15.00) |
.085a
|
10.48 (6.30-14.80) |
10.29 (5.50-15.40) |
.510a
|
Ca (mg/dL) |
9.13 (4.00-14.60) |
9.35 (6.70-15.10) |
.131a
|
9.14 (4.00-14.10) |
9.56 (7.10–15.10) |
.098a
|
9.57 (7.10-15.10) |
9.14 (4.00-13.80) |
.928a
|
Serum protein (g/dL) |
8.22 (3.90-17.00) |
8.17 (4.70-13.60) |
.453a
|
8.30 (3.90-17.00) |
7.93 (4.70-12.50) |
.280a
|
7.90 (4.60-12.50) |
8.30 (3.90-17.00) |
.373a
|
24 hr urine protein (mg/day) |
2,092 (11-13,947) |
2,123 (9-14,286) |
.912a
|
2,049 (9-14,286) |
2,261 (11-13,947) |
.793a
|
1,749 (11-13,947) |
2,250 (9-14,286) |
.238a
|
WBC count (× 109/L) |
5.72 (2.40-12.70) |
6.86 (2.90-17.40) |
.001a
|
5.55 (2.40-16.00) |
8.40 (4.40-17.40) |
< .0001a
|
7.44 (2.40-17.00) |
5.99 (2.40-17.40) |
.003a
|
Platelets (× 109/L) |
176 (23-461) |
225 (39-663) |
.001a
|
194 (31-523) |
231 (23-663) |
.028a
|
199 (23-663) |
208 (38-584) |
.448a
|
Table 2.Univariate analyses of ALC, AMC, and the ALC/AMC ratio for OS
Factor |
|
HR |
95% CI |
p-value |
ALC (cells/µL) |
≥ 1,400 vs < 1,400 |
1.649 |
1.189-2.286 |
.002 |
AMC (cells/µL) |
< 490 vs ≥ 490 |
1.443 |
1.018-2.045 |
.038 |
ALC/AMC ratio |
≥ 2.9 vs < 2.9 |
1.772 |
1.249-2.514 |
.001 |
Morphology |
Plasmacytic vs plasmablastic |
1.552 |
1.081-2.228 |
.016 |
Age (yr) |
< 65 vs ≥ 65 |
1.793 |
1.279-2.513 |
.001 |
ISS |
I |
1 |
|
|
|
II |
2.148 |
1.258-3.670 |
.005 |
|
III |
4.360 |
2.526-7.523 |
< .0001 |
D-S stage |
I |
1 |
|
|
|
II |
1.982 |
1.061-3.702 |
.032 |
|
IIIA |
1.403 |
0.769-2.560 |
.270 |
|
IIIB |
3.368 |
1.712-6.627 |
< .0001 |
β2-Microglobulin (mg/L) |
< 3.5 vs ≥ 3.5 |
2.128 |
1.468-3.084 |
< .0001 |
Albumin (g/dL) |
< 3.5 vs ≥ 3.5 |
1.573 |
1.115-2.219 |
.009 |
Bone lesion (lytic bone lesions) |
< 3 vs ≥ 3 |
1.108 |
0.799-1.535 |
.539 |
Treatment type |
ASCT vs no ASCT |
2.345 |
1.637-3.359 |
< .0001 |
Table 3.Multivariate analyses of ALC, AMC, and the ALC/AMC ratio for OS
Factors |
|
HR |
95% CI |
p-value |
HR |
95% CI |
p-value |
ALC (cells/µL) |
≥ 1,400 vs < 1,400 |
1.389 |
0.933-2.069 |
.106 |
|
|
|
AMC (cells/µL) |
< 490 vs ≥ 490 |
1.415 |
0.928-2.157 |
.107 |
|
|
|
ALC/AMC ratio |
≥ 2.9 vs < 2.9 |
|
|
|
1.511 |
1.006-2.272 |
.047 |
Morphology |
Plasmacytic vs plasmablastic |
1.396 |
0.940-2.074 |
.099 |
1.366 |
0.917-2.033 |
.125 |
Age (yr) |
< 65 vs ≥ 65 |
1.441 |
0.949-2.189 |
.087 |
1.388 |
0.910-2.116 |
.128 |
ISS |
I |
1 |
|
|
1 |
|
|
|
II |
1.129 |
0.543-2.348 |
.745 |
1.122 |
0.540-2.331 |
.757 |
|
III |
1.799 |
0.824-3.925 |
.140 |
2.048 |
0.947-4.429 |
.069 |
D-S stage |
I |
1 |
|
|
1 |
|
|
|
II |
1.089 |
0.454-2.611 |
.849 |
1.151 |
0.482-2.750 |
.751 |
|
IIIA |
0.997 |
0.427-2.326 |
.994 |
1.099 |
0.479-2.520 |
.824 |
|
IIIB |
1.786 |
0.681-4.683 |
.239 |
1.899 |
0.725-4.975 |
.192 |
Treatment type |
ASCT vs no ASCT |
2.252 |
1.405-3.610 |
.001 |
2.131 |
1.337-3.396 |
.001 |
Table 4.Stratified univariate analyses for OS
Characteristics |
ALC < 1,400 cells/µL
|
AMC ≥ 490 cells/µL
|
ALC/AMC < 2.9
|
HR |
95% CI |
p-value |
HR |
95% CI |
p-value |
HR |
95% CI |
p-value |
Treatment |
|
|
|
|
|
|
|
|
|
ASCT (n = 67) |
1.459 |
0.794-2.679 |
.221 |
1.376 |
0.728-2.600 |
.323 |
1.393 |
0.700-2.769 |
.343 |
No ASCT (n = 122) |
1.542 |
1.043-2.281 |
.029 |
1.613 |
1.058-2.457 |
.025 |
1.850 |
1.227-2.789 |
.003 |
Age (yr) |
|
|
|
|
|
|
|
|
|
< 65 (n = 121) |
1.728 |
1.139-2.622 |
.009 |
1.517 |
0.971-2.369 |
.065 |
1.843 |
1.163-2.920 |
.008 |
≥ 65 (n = 68) |
1.606 |
0.934-2.762 |
.084 |
1.323 |
0.752-2.327 |
.330 |
1.408 |
0.812-2.442 |
.221 |
Sex |
|
|
|
|
|
|
|
|
|
Male (n = 98) |
2.112 |
1.351-3.301 |
.001 |
1.259 |
0.806-1.967 |
.310 |
1.719 |
1.091-2.708 |
.018 |
Female (n = 91) |
1.245 |
0.764-2.028 |
.379 |
1.433 |
0.748-2.744 |
.276 |
1.559 |
0.873-2.784 |
.130 |
ISS |
|
|
|
|
|
|
|
|
|
I (n = 35) |
1.303 |
0.451-3.761 |
.624 |
6.865 |
2.408-19.576 |
< .0001 |
3.169 |
1.166-8.617 |
.017 |
II (n = 87) |
1.720 |
1.044-2.834 |
.031 |
0.982 |
0.563-1.712 |
.949 |
1.209 |
0.693-2.110 |
.504 |
III (n = 61) |
0.936 |
0.554-1.580 |
.804 |
1.171 |
0.683-2.005 |
.566 |
2.011 |
1.172-3.450 |
.010 |