Complete Blood Count Score Model Integrating Reduced Lymphocyte-Monocyte Ratio, Elevated Neutrophil-Lymphocyte Ratio, and Elevated Platelet-Lymphocyte Ratio Predicts Inferior Clinical Outcomes in Adult T-Lymphoblastic Lymphoma

Abstract

Abstract Background T-lymphoblastic lymphoma (T-LBL) is a highly aggressive neoplasm of lymphoblasts of T-cell origin. Although promising improvements have been recently achieved, one third of patients experience relapse or refractory T-LBL. Therefore, optimal strategies for identifying high-risk patients are urgently needed. Materials and Methods In the present study, 75 newly diagnosed adult patients (aged ≥15 years) with T-LBL were identified and the predictive value of complete blood count (CBC) abnormalities, including lymphocyte-monocyte ratio (LMR), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) on clinical outcomes, was analyzed. Results Using the receiver operating characteristic curve to determine the best cutoff values based on survival, it was found that patients with T-LBL with LMR ≤2.8, NLR ≥3.3, and PLR ≥200 had both inferior progression-free survival (PFS) and inferior overall survival (OS), in which the differences were much more remarkable in the international prognostic index score 0–2 subgroup. In the multivariable analysis, NLR ≥3.3 together with age >40 years and central nervous system (CNS) involvement were identified to be independently associated with shortened PFS, whereas PLR ≥200 and CNS involvement were identified to be independent risk factors for OS. LMR, NLR, and PLR were integrated to generate a “CBC score” model, which well separated adult patients with T-LBL into three risk groups, and the 3-year OS was 84%, 53%, and 30% for low-, intermediate-, and high-risk patients, respectively. Conclusion Overall, a “CBC score” model was initially promoted for stratification in adult patients with T-LBL using simple, widely available, and easy to interpret parameters in the largest adult T-LBL cohort to date. Implications for Practice Optimal strategies for identifying high-risk patients with T-lymphoblastic lymphoma (T-LBL) are urgently needed. In the largest adult T-LBL cohort to date, simple, inexpensive, widely available parameters were applied and revealed that patients with lymphocyte-monocyte ratio (LMR) ≤2.8, neutrophil-lymphocyte ratio (NLR) ≥3.3, and platelet-lymphocyte ratio (PLR) ≥200 had both inferior progression-free survival and inferior overall survival (OS), in which the differences were much more remarkable in the international prognostic index score 0–2 subgroup. LMR, NLR, and PLR were integrated to generate a “complete blood count score” model, in which the 3-year OS was 84%, 53%, and 30% for low-, intermediate-, and high-risk patients, respectively.