LMR Predicts PFS And Early Relapse In High Tumor Burden FL

In a retrospective study conducted at a single center, encompassing an unselected cohort of individuals with Follicular Lymphoma (FL), it was observed that a lower peripheral blood Lymphocyte-to-Monocyte Ratio (LMR) correlated with older age and increased tumor burden. A lower LMR predicted reduced progression-free and overall survival (PFS, OS), an elevated risk of histological transformation, and the development of secondary primary malignancies (Mozas, Leukemia & Lymphoma, 2020).

This study assessed the impact of LMR among patients (pts) enrolled in the phase III RELEVANCE trial. This trial involved individuals with previously untreated FL and high tumor burden, comparing the efficacy of rituximab-chemotherapy (R-chemo) against rituximab-lenalidomide (R²).

Researchers employed Xtile and the maxstat package of R software to determine the optimal LMR cutoff based on PFS data. This cutoff was subsequently validated using a truncated power basis spline method. Comparative analyses were conducted across LMR risk groups, examining baseline characteristics, PFS assessed by investigators, early relapse (POD24), and OS. For survival analyses, multivariable Cox regression models were constructed, which incorporated the FLIPI score and the treatment arm. In addition, uni/multivariable logistic regression for the analysis of POD24 was used.

Of the 1030 pts enrolled in the RELEVANCE study, 1018 individuals had accessible LMR data. The median LMR recorded was 2.5 (with a range from 0 to 93), and an LMR cutoff value of 2 emerged as the most effective in predicting Progression-Free Survival (PFS). Among those with an LMR ≤2 (n = 372, constituting 37% of the cohort), older age was prevalent, and they displayed higher-risk characteristics. In the global cohort, having an LMR ≤2 was associated with a predictive value for a shorter PFS (Hazard Ratio, HR = 1.39) and Overall Survival (HR = 1.44). However, within the multivariable model, the adverse effect of LMR ≤2 remained statistically significant solely for PFS (HR for LMR = 1.31). Similarly, an LMR ≤2 was linked to an increased likelihood of experiencing an early relapse (POD24) (univariable Odds Ratio, OR = 1.84; multivariable OR = 1.71). Notably, no significant interaction was observed between treatment arms and LMR in the PFS analysis. However, the LMR was notably associated with PFS exclusively in the R-chemo arm (P = 0.001) and not in the R² arm (P = 0.08).

The study showed that the LMR strongly predicts PFS and early relapse in patients with high tumor burden FL. Further investigation is needed to ascertain whether treatment strategies involving immunomodulators like lenalidomide can mitigate its negative prognostic impact.

Source: https://onlinelibrary.wiley.com/doi/10.1002/hon.3164_200

Clinical Trial: https://classic.clinicaltrials.gov/ct2/show/NCT01650701

Mozas, P., Ammar, R.O., Chartier, L., Nastoupil, L., Bachy, E., Bezsera, S.M., Barnes, J., Bijou, F., Goy, A., Zerazhi, H., Cartron, G., Ojeda-Uribe, M., Choquet, S., Joly, B., Cheminant, M., García-Sancho, A.M., Eradat, H., Gressin, R., Abrisqueta, P., Parcelier, A., Salazar, M.J.R., Bonnet, C., Crump, M., López-Guillermo, A., Morschhauser, F. A low lymphocyte-to-monocyte ratio (LMR) predicts PFS, POD24 and OS in previously untreated, high tumor burden follicular lymphoma (FL): an analysis from the RELEVANCE trial. https://doi.org/10.1002/hon.3164_200