[Prognostic Value of Prognostic Nutritional Index and Lymphocyte-to-Monocyte Ratio in Patients with Follicular Lymphoma].

[OBJECTIVE] To investigate the prognostic value of prognostic nutritional index (PNI) and lymphocyte-to-monocyte ratio (LMR) in patients with follicular lymphoma (FL).

[METHODS] The baseline clinical data of 120 newly diagnosed FL patients admitted to the Department of Hematology of the Affiliated Hospital of Xuzhou Medical University from February 2014 to May 2023 were analyzed retrospectively. The optimal cutoff values of PNI, LMR and neutrophil-to-lymphocyte ratio (NLR) were determined by receiver operating characteristic (ROC) curve analysis. Cox proportional hazards model was used for univariate and multivariate analyses. Kaplan-Meier method was used for survival analysis, and log-rank test was adopted for intergroup comparison.

[RESULTS] The optimal cutoff values of PNI, LMR and NLR were 47.35, 3.46 and 2.59, respectively. The results of the test showed that Eastern Cooperative Oncology Group performance status (ECOG PS) score≥2, the long diameter of the largest lymph node > 6 cm, histological grade 3, elevated lactate dehydrogenase (LDH), high risk score of the follicular lymphoma international prognostic index (FLIPI), low PNI, low LMR and high NLR were significantly correlated with the increased risk of progression of disease within 24 months (POD24) ( < 0.05). The results of univariate analysis showed that age≥60 years old, male, ECOG PS score≥2, the long diameter of the largest lymph node > 6 cm, hemoglobin (Hb) < 120 g/L, elevated LDH, low PNI, low LMR, high NLR, high-density lipoprotein cholesterol (HDL-C) < 40 mg/dl, and high-risk scores of FLIPI and FLIPI2 were associated with poor progression-free survival (PFS) and overall survival (OS) in FL patients ( < 0.05). The results of multivariate analysis showed that low PNI and low LMR were independent risk factors affecting the OS in FL patients, and low PNI was also an independent risk factor affecting the PFS of FL patients. The use of anti-CD20 monoclonal antibody in first-line treatment and maintenance therapy could improve the remission rate, showing benefits for PFS and OS. In addition, integrating PNI and LMR into FLIPI and FLIPI2 scores was helpful to better predict the PFS and OS of patients in different risk groups.

[CONCLUSIONS] PNI and LMR are independent prognostic factors for FL patients, and the composite biomarker composed of PNI, LMR and FLIPI or FLIPI2 demonstrated enhanced accuracy in predicting prognosis for FL patients.