J Hematol

Journal of Hematology, ISSN 1927-1212 print, 1927-1220 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Hematol and Elmer Press Inc

Journal website https://www.thejh.org

Original Article

Volume 9, Number 4, December 2020, pages 116-122

Prognostic Role of Lymphocyte/Monocyte Ratio in Chronic Lymphocytic Leukemia

**Table 1.** Demographic and Clinical Features of Patients (Laboratory and Genetic Results)
	Range	Median	Mean ± SD or %
Demographic data such as age and gender, basal leukocyte, absolute lymphocyte and absolute monocyte counts; Rai and Binet Stages; cytogenetic examination (chromosome analysis and FISH analysis) results, follow-up period and treatment results were seen in Table 1. ^aCytogenetic results of all patients at initial diagnosis could not be reached. SD: standard deviation; FISH: fluorescence in situ hybridization; WBC: white blood cell; LMR: lymphocyte/monocyte ratio; ALC: absolute lymphocyte count; AMC: absolute monocyte count.
Age	35 - 85	66	65.5 ± 10.3
Gender
Male			109	63.0%
Female			64	37.0%
WBC × 10⁹/L	3.93 - 315.0	27.6	46.4 ± 54.1
ALC × 10⁹/L	1.5 - 282.1	21.54	37.9 ± 49.0
AMC × 10⁹/L	0.01 - 19.0	0.79	1.5 ± 2.4
LMR	0.66 - 2,464.5	26.7	121.5 ± 344.5
Rai Stage
0			44	25.4%
I			52	30.1%
II			32	18.5%
III			28	16.2%
IV			17	9.8%
Binet Stage
A			100	57.8%
B			53	30.6%
C			20	11.6%
Cytogenetic analysis^a
(+)			123	71.1%
(-)			50	28.9%
Del13q14
(-)			68	64.8%
(+)			37	35.2%
Del11q
(-)			90	88.2%
(+)			12	11.8%
Del17p
(-)			108	90.8%
(+)			11	9.2%
Trisomy 12
(-)			78	80.4%
(+)			19	19.6%
Follow-up period (month)	0.03 - 166.2	35.50	39.12 ± 30.9
Treatment
(-)			100	57.8%
(+)			73	42.2%
Response to first-line treatment
(-)			21	28.8%
(+)			52	71.2%
Lines of treatment
1 or 2			56	76.7%
≥ 3			17	23.3%
Progression
(-)			129	74.6%
(+)			44	25.4%
Last situation
Alive			146	84.4%
Death			27	15.6%

Table 1. Demographic and Clinical Features of Patients (Laboratory and Genetic Results)

Range

Median

Mean ± SD or %

Demographic data such as age and gender, basal leukocyte, absolute lymphocyte and absolute monocyte counts; Rai and Binet Stages; cytogenetic examination (chromosome analysis and FISH analysis) results, follow-up period and treatment results were seen in Table 1. ^aCytogenetic results of all patients at initial diagnosis could not be reached. SD: standard deviation; FISH: fluorescence in situ hybridization; WBC: white blood cell; LMR: lymphocyte/monocyte ratio; ALC: absolute lymphocyte count; AMC: absolute monocyte count.

Age

35 - 85

65.5 ± 10.3

Gender

Male

109

63.0%

Female

37.0%

WBC × 10⁹/L

3.93 - 315.0

27.6

46.4 ± 54.1

ALC × 10⁹/L

1.5 - 282.1

21.54

37.9 ± 49.0

AMC × 10⁹/L

0.01 - 19.0

0.79

1.5 ± 2.4

LMR

0.66 - 2,464.5

26.7

121.5 ± 344.5

Rai Stage

25.4%

30.1%

18.5%

III

16.2%

9.8%

Binet Stage

100

57.8%

30.6%

11.6%

Cytogenetic analysis^a

(+)

123

71.1%

(-)

28.9%

Del13q14

(-)

64.8%

(+)

35.2%

Del11q

(-)

88.2%

(+)

11.8%

Del17p

(-)

108

90.8%

(+)

9.2%

Trisomy 12

(-)

80.4%

(+)

19.6%

Follow-up period (month)

0.03 - 166.2

35.50

39.12 ± 30.9

Treatment

(-)

100

57.8%

(+)

42.2%

Response to first-line treatment

(-)

28.8%

(+)

71.2%

Lines of treatment

1 or 2

76.7%

≥ 3

23.3%

Progression

(-)

129

74.6%

(+)

25.4%

Last situation

Alive

146

84.4%

Death

15.6%

**Table 2.** LMR-Age and LMR-Monocyte Correlations
	Age	WBC	Lymphocyte	Monocyte	Rai Stage
As a result of correlation analysis (Spearman correlation), no significant correlation was observed between LMR and age, whereas a significant positive correlation was observed between leukocyte and lymphocyte counts. A significant negative correlation was observed between the LMR and the number of monocytes. A significant correlation was also observed between LMR and Rai Stages. WBC: white blood cell; LMR: lymphocyte/monocyte ratio.
LMR, R	0.030	0.474	0.525	-0.438	0.312
LMR, P	0.694	0.000	0.000	0.000	0.000

Table 2. LMR-Age and LMR-Monocyte Correlations

Age

WBC

Lymphocyte

Monocyte

Rai Stage

As a result of correlation analysis (Spearman correlation), no significant correlation was observed between LMR and age, whereas a significant positive correlation was observed between leukocyte and lymphocyte counts. A significant negative correlation was observed between the LMR and the number of monocytes. A significant correlation was also observed between LMR and Rai Stages. WBC: white blood cell; LMR: lymphocyte/monocyte ratio.

LMR, R

0.030

0.474

0.525

-0.438

0.312

LMR, P

0.694

0.000

**Table 3.** Relationship Between LMR and Rai or Binet Stages
	LMR	P
^aWhen the relationship between LMR and Rai Stages was examined, it was seen that LMR increased significantly as the Rai Stage increased; ^bWhen the relationship between LMR and Binet Stages is examined, the median LMR was 24.4 in stage A, 31 in stage B and 41.1 in stage C; in Binet Stage C, LMR was seen to be significantly higher than that in stage A (P < 0.05); in Binet Stage B, LMR was not significantly different from stages A and C;^cKruskal-Wallis (Mann-Whitney U test). LMR: lymphocyte/monocyte ratio; SD: standard deviation.
Rai^a
0	4.9 - 950.0	22.6	48.3 ± 141.3	0.000^c
I	0.7 - 734.0	15.9	63.3 ± 125.3
II	1.4 - 567.9	29.7	62.2 ± 101.6
III	5.4 - 2,464.5	32.7	325.8 ± 707.3
IV	10.9 - 1,519.3	73.1	264.3 ± 424.2
A	0.7 - 950.0	24.4	57.7 ± 130.0
Binet^b
B	1.4 - 2,326.0	31.0	161.4 ± 404.4
C	10.9 - 2,464.5	41.1	334.7 ± 681.7	0.008

Table 3. Relationship Between LMR and Rai or Binet Stages

LMR

Min - max

Median

Mean ± SD

^aWhen the relationship between LMR and Rai Stages was examined, it was seen that LMR increased significantly as the Rai Stage increased; ^bWhen the relationship between LMR and Binet Stages is examined, the median LMR was 24.4 in stage A, 31 in stage B and 41.1 in stage C; in Binet Stage C, LMR was seen to be significantly higher than that in stage A (P < 0.05); in Binet Stage B, LMR was not significantly different from stages A and C;^cKruskal-Wallis (Mann-Whitney U test). LMR: lymphocyte/monocyte ratio; SD: standard deviation.

Rai^a

4.9 - 950.0

22.6

48.3 ± 141.3

0.000^c

0.7 - 734.0

15.9

63.3 ± 125.3

1.4 - 567.9

29.7

62.2 ± 101.6

III

5.4 - 2,464.5

32.7

325.8 ± 707.3

10.9 - 1,519.3

73.1

264.3 ± 424.2

0.7 - 950.0

24.4

57.7 ± 130.0

Binet^b

1.4 - 2,326.0

31.0

161.4 ± 404.4

10.9 - 2,464.5

41.1

334.7 ± 681.7

0.008

**Table 4.** Relationship of LMR With Progression
	LMR	P
During follow-up, at any time, the group with disease progression had a significantly higher LMR value than the group without progression. In addition, the LMR value was significantly higher in patients who died than others.^aMann-Whitney U test. LMR: lymphocyte/monocyte ratio; SD: standard deviation.
Progression
(-)	0.7 - 2,464.5	24.6	102.1 ± 321.4	0.022^a
(+)	1.4 - 2,326.0	43.2	178.3 ± 403.3
Last situation
Alive	0.7 - 2,464.5	25.0	110.1 ± 320.8	0.049^a
Death	2.4 - 2,326.0	57.4	183.2 ± 454.1

Table 4. Relationship of LMR With Progression

LMR

Min - max

Median

Mean ± SD

During follow-up, at any time, the group with disease progression had a significantly higher LMR value than the group without progression. In addition, the LMR value was significantly higher in patients who died than others.^aMann-Whitney U test. LMR: lymphocyte/monocyte ratio; SD: standard deviation.

Progression

(-)

0.7 - 2,464.5

24.6

102.1 ± 321.4

0.022^a

(+)

1.4 - 2,326.0

43.2

178.3 ± 403.3

Last situation

Alive

0.7 - 2,464.5

25.0

110.1 ± 320.8

0.049^a

Death

2.4 - 2,326.0

57.4

183.2 ± 454.1

**Table 5.** LMR and OS and PFS
	PFS (month)^a	95% CI	P
LMR ≤ 26	107.2	81.6 - 132.8
LMR > 26	80.6	64.2 - 97.0	0.110
Total	96.5	78.8 - 114.1
Kaplan-Meier (log-rank) method was used in survival analysis. ^aPFS was 107.2 months in patient group with LMR ≤ 26 (95% CI: 81.6 - 132.8, P > 0.05) and 80.6 months in patient group with LMR > 26 (95% CI: 64.2 - 97, P > 0.05). No statistically significant relationship was detected. The median PFS value of our study was calculated as 96.5 months in total. ^bOS was 131.8 months in patient group with LMR ≤ 26 (95% CI: 110.9 - 152.7, P > 0.05) and 98.1 months in patient group with LMR > 26 (95% CI: 81 - 115.2, P > 0.05). No statistically significant relationship was found. In our study, the OS was calculated as 120.6 months in all patients. PFS: progression-free survival; OS: overall survival; LMR: lymphocyte/monocyte ratio; CI: confidence interval.
LMR ≤ 26	131.8	110.9 - 152.7
LMR > 26	98.1	81.0 - 115.2	0.111
Total	120.6	104.6 - 136.5

Table 5. LMR and OS and PFS

PFS (month)^a

95% CI

LMR ≤ 26

107.2

81.6 - 132.8

LMR > 26

80.6

64.2 - 97.0

0.110

Total

96.5

78.8 - 114.1

OS (month)^b

95% CI

Kaplan-Meier (log-rank) method was used in survival analysis. ^aPFS was 107.2 months in patient group with LMR ≤ 26 (95% CI: 81.6 - 132.8, P > 0.05) and 80.6 months in patient group with LMR > 26 (95% CI: 64.2 - 97, P > 0.05). No statistically significant relationship was detected. The median PFS value of our study was calculated as 96.5 months in total. ^bOS was 131.8 months in patient group with LMR ≤ 26 (95% CI: 110.9 - 152.7, P > 0.05) and 98.1 months in patient group with LMR > 26 (95% CI: 81 - 115.2, P > 0.05). No statistically significant relationship was found. In our study, the OS was calculated as 120.6 months in all patients. PFS: progression-free survival; OS: overall survival; LMR: lymphocyte/monocyte ratio; CI: confidence interval.

LMR ≤ 26

131.8

110.9 - 152.7

LMR > 26

98.1

81.0 - 115.2

0.111

Total

120.6

104.6 - 136.5