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

  • Authors:
    • Ngoc Dung Nguyen
    • Minh Phuong Vu
    • Hoang Vu
    • Phuong Thao Pham
    • Tuan Tung Nguyen
    • Thi Van Oanh Kieu
    • Hai Yen Duong
    • Thi Tuyet Mai Nguyen
    • Thi Hue Hoang
  • View Affiliations / Copyright

    Affiliations: Department of Cytomorphology and Histology, National Institute of Hematology and Blood Transfusion, Hanoi 11312, Vietnam, Department of Hematology, Hanoi Medical University, Hanoi 11521, Vietnam, Hematology and Blood Transfusion Center, Bach Mai Hospital, Hanoi 11519, Vietnam
    Copyright: © Nguyen et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
  • Article Number: 26
    |
    Published online on: February 18, 2026
       https://doi.org/10.3892/wasj.2026.441
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Abstract

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).
View Figures

Figure 1

Receiver operating characteristic
curve analysis demonstrating the ability of NLR (neutrophil to
lymphocyte ratio) to discriminate between survival and
mortality.

Figure 2

Patient overall survival according to
the bone marrow plasma cell percentage (≥40% vs. <40%).

Figure 3

Patient progression-free survival
according to bone marrow plasma cell percentage (≥40% vs.
<40%).

Figure 4

Patient overall survival according to
platelet count (<150x109/l vs.
≥150x109/l).

Figure 5

Patient progression-free survival
according to platelet count (<150x109/l vs.
≥150x109/l).

Figure 6

Patient overall survival according to
neutrophil to lymphocyte ratio (≥2.1 vs. <2.1).

Figure 7

Patient progression-free survival
according to neutrophil to lymphocyte ratio (≥2.1 vs. <2.1).

Figure 8

Patient overall survival according to
the calcium level (≥2.75 mmol/l vs. <2.75 mmol/l).

Figure 9

Patient progression-free survival
according to the calcium level (≥2.75 mmol/l vs. <2.75
mmol/l).
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Copy and paste a formatted citation
Spandidos Publications style
Nguyen ND, Vu MP, Vu H, Pham PT, Nguyen TT, Kieu TO, Duong HY, Nguyen TM and Hoang TH: Comparison of the prognostic value of the neutrophil to lymphocyte ratio with other prognostic indices in the prognosis of patients diagnosed with multiple myeloma. World Acad Sci J 8: 26, 2026.
APA
Nguyen, N.D., Vu, M.P., Vu, H., Pham, P.T., Nguyen, T.T., Kieu, T.O. ... Hoang, T.H. (2026). Comparison of the prognostic value of the neutrophil to lymphocyte ratio with other prognostic indices in the prognosis of patients diagnosed with multiple myeloma. World Academy of Sciences Journal, 8, 26. https://doi.org/10.3892/wasj.2026.441
MLA
Nguyen, N. D., Vu, M. P., Vu, H., Pham, P. T., Nguyen, T. T., Kieu, T. O., Duong, H. Y., Nguyen, T. M., Hoang, T. H."Comparison of the prognostic value of the neutrophil to lymphocyte ratio with other prognostic indices in the prognosis of patients diagnosed with multiple myeloma". World Academy of Sciences Journal 8.2 (2026): 26.
Chicago
Nguyen, N. D., Vu, M. P., Vu, H., Pham, P. T., Nguyen, T. T., Kieu, T. O., Duong, H. Y., Nguyen, T. M., Hoang, T. H."Comparison of the prognostic value of the neutrophil to lymphocyte ratio with other prognostic indices in the prognosis of patients diagnosed with multiple myeloma". World Academy of Sciences Journal 8, no. 2 (2026): 26. https://doi.org/10.3892/wasj.2026.441
Copy and paste a formatted citation
x
Spandidos Publications style
Nguyen ND, Vu MP, Vu H, Pham PT, Nguyen TT, Kieu TO, Duong HY, Nguyen TM and Hoang TH: Comparison of the prognostic value of the neutrophil to lymphocyte ratio with other prognostic indices in the prognosis of patients diagnosed with multiple myeloma. World Acad Sci J 8: 26, 2026.
APA
Nguyen, N.D., Vu, M.P., Vu, H., Pham, P.T., Nguyen, T.T., Kieu, T.O. ... Hoang, T.H. (2026). Comparison of the prognostic value of the neutrophil to lymphocyte ratio with other prognostic indices in the prognosis of patients diagnosed with multiple myeloma. World Academy of Sciences Journal, 8, 26. https://doi.org/10.3892/wasj.2026.441
MLA
Nguyen, N. D., Vu, M. P., Vu, H., Pham, P. T., Nguyen, T. T., Kieu, T. O., Duong, H. Y., Nguyen, T. M., Hoang, T. H."Comparison of the prognostic value of the neutrophil to lymphocyte ratio with other prognostic indices in the prognosis of patients diagnosed with multiple myeloma". World Academy of Sciences Journal 8.2 (2026): 26.
Chicago
Nguyen, N. D., Vu, M. P., Vu, H., Pham, P. T., Nguyen, T. T., Kieu, T. O., Duong, H. Y., Nguyen, T. M., Hoang, T. H."Comparison of the prognostic value of the neutrophil to lymphocyte ratio with other prognostic indices in the prognosis of patients diagnosed with multiple myeloma". World Academy of Sciences Journal 8, no. 2 (2026): 26. https://doi.org/10.3892/wasj.2026.441
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