Comparison of the prognostic value of the neutrophil to lymphocyte ratio with other prognostic indices in the prognosis of patients diagnosed with multiple myeloma

The high neutrophil to lymphocyte ratio (NLR) is a poor prognostic factor for patients with multiple myeloma (MM); however, it has yet to be widely recognized in clinical practice. The present study was conducted to determine the value of NLR in the prognosis of patients with MM, compared with other prognostic indices. In total, 109 patients with newly diagnosed MM who were undergoing chemotherapy were recruited in the present retrospective cohort study. The prognostic factors subjected to analysis for survival time were determined at the time of pre‑treatment. The results of the univariate and multivariate analyses revealed that only a high bone marrow plasma cell percentage (≥40%), a low platelet count (<150x10⁹/l), a high NLR (≥2.1) and a high calcium level (≥2.75 mmol/l) were poor prognostic factors for both overall survival (OS) and progression‑free survival (PFS). In the OS analysis, the hazard ratios (HRs) of a high bone marrow plasma cell percentage (≥40%), low platelet count (<150x10⁹/l), high NLR (≥2.1) and high calcium level (≥2.75 mmol/l) were 1.900, 1.839, 2.605 and 2.665, with P=0.039, 0.049, 0.003 and 0.003, respectively. The absolute value of standardized coefficient β values for OS were 0.065, 0.039, 0.141 and 0.212, respectively. In the PFS analysis, the HRs of high bone marrow plasma cell percentage (≥40%), low platelet count (<150x10⁹/l), high NLR (≥2.1) and high calcium level (≥2.75 mmol/l) were 1.721, 1.876, 2.326 and 2.354, with P=0.044, 0.026, 0.002 and 0.004, respectively. Moreover, values for the absolute value of standardized coefficient β (for PFS) were 0.149, 0.099, 0.186 and 0.207. Collectively, the results of the present study revealed that a high NLR (≥2.1) may exhibit a higher potential for determining a poor prognosis than a high bone marrow plasma cell percentage (≥40%) and a low platelet count (<150x10⁹/l); however, it may be less useful than high calcium levels (≥2.75 mmol/l).