Absolute Lymphocyte Count at Day 29 of Treatment Is a Powerful Predictor of Outcome in Multiple Myeloma

Multiple myeloma is a malignancy of the bone marrow. Despite advances, the overall prognosis remains poor with median survival of 4-5 years. In a retrospective analysis of 38 patients, we find that the day 29 lymphocyte count, measured four weeks after starting treatment, can powerfully predict prognosis. This simple test can guide optimal management and yields insights into the disease. Background: Survival outcomes for patients who receive treatment for newly diagnosed multiple myeloma (MM) are highly variable. Patients and Methods: We conducted a retrospective analysis of 38 unselected MM patients who received treatment with cyclophosphamide, thalidomide, and dexamethasone to evaluate the prognostic value of the absolute lymphocyte count at diagnosis and at the end of the initial cycle of treatment defined as day 29, termed ALC-29. The median follow-up was 54 months (range, 2-83 months). Results: We found that ALC-29, as a continuous variable, was a predictor of overall survival (OS) in MM patients (hazard ratio, 0.208; 95% confidence interval, 0.093-0.689; P = .007). Patients with an ALC-29 >= 0.8 x 10(9)/L (n = 16) experienced a superior median OS compared with patients with an ALC-29 <0.8 x 10(9)/L (n = 22) with a median OS of 58.3 months versus 42.5 months respectively (P = .006). Multivariate analysis confirmed that ALC-29 >= 0.8 x 10(9)/L was an independent prognostic indicator of OS in our cohort of MM patients. Conclusion: We concluded that the ALC-29 is a useful and simple predictor of outcome in newly diagnosed MM patients who receive standard chemotherapy. Our results support the hypothesis that host immunity plays an important role in tumor control in MM. (C) 2015 Elsevier Inc. All rights reserved.