Could ratio of hemoglobin to red cell distribution width and ratio of absolute lymphocyte count to absolute monocyte count be a prognostic tool in newly diagnosed multiple myeloma patients?

AbstractIntroductionHemoglobin/red cell distribution width (RDW) ratio (HRR) and lymphocyte-to-monocyte ratio (LMR) are two novel bio-markers associated with overall survival (OS) and prognosis in several types of cancers. The aim of this study is to investigate the value of HRR and LMR in newly diagnosed multiple myeloma (MM) patients.MethodsA total of 180 patients were included in this study. Patients diagnosed with MM between May 2013 and May 2019 at a single center were evaluated. HRR was calculated by dividing hemoglobin to RDW, both measured from the same sample. LMR was calculated by dividing absolute lymphocyte count (ALC) to absolute monocyte count (AMC).ResultsThe cutoff value for HRR was taken as 0.61, and the cutoff value for LMR was taken as 3.28. Patients were divided into low HRR, high HRR, low LMR, and high LMR groups. OS of the patients with low HRR was found lower compared with high HRR (36.7 months for low HRR and 53.2 months for high HRR, p < 0.001). Also, OS was found lower in the low LMR group (39.4 months for low LMR and 51.7 months for high LMR, p = 0.016). On multivariate analysis, low HRR and low LMR were predictive factors of OS (hazard ratio (HR) 2.08, 95% confidence intervals (CI) 1.31–3.03, and p = 0.002 for low HRR; HR 1.47, 95% CI 0.92–2.29, and p = 0.010 for low LMR).ConclusionCombining both HRR and LMR could be a prognostic biomarker and it reflects the status of the immune system in newly diagnosed MM patients.

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High Red Cell Distribution Width and Low Absolute Lymphocyte Count Associate With Subsequent Mortality in HCV Infection

Pathogens and Immunity ◽

10.20411/pai.v6i2.467 ◽

2021 ◽

Vol 6 (2) ◽

pp. 90-104

Author(s):

Sofi Damjanovska ◽

Perica Davitkov ◽

Surya Gopal ◽

Lenche Kostadinova ◽

Corrine Kowal ◽

...

Keyword(s):

Cardiovascular Disease ◽

Liver Disease ◽

Lymphocyte Count ◽

Transient Elastography ◽

Absolute Lymphocyte Count ◽

Hcv Infection ◽

Red Cell Distribution Width ◽

Red Cell ◽

Cell Distribution ◽

Distribution Width

Background: Hepatitis-C virus (HCV) chronic infection can lead to cirrhosis, hepatocellular carcinoma (HCC), end-stage liver disease, cardiovascular disease (CVD), and mortality. Transient Elastography (TE) is used to non-invasively assess fibrosis. Whether immune monitoring provides additive prognostic value is not established. Increased red-cell distribution width (RDW) and decreased absolute lymphocyte count (ALC) predict mortality in those without liver disease. Whether these relationships remain during HCV infection is unknown. Materials and Methods: A retrospective cohort of 1,715 single-site VA Liver Clinic patients receiving Transient Elastography (TE) 2014-2019 to evaluate HCV-associated liver damage were evaluated for RDW and ALC in relation to traditional parameters of cardiovascular risk, liver health, development of HCC, and mortality. Results: The cohort was 97% male, 55% African American, 26% with diabetes mellitus, 67% with hypertension, and 66% with tobacco use. After TE, 3% were subsequently diagnosed with HCC, and 12% (n=208) died. Most deaths (n=189) were due to non-liver causes. The TE score associated with prevalent CVD positively correlated with atherosclerotic cardiovascular disease (ASCVD) 10-Year Risk Score, age, RDW, and negatively correlated with ALC. Patients with anisocytosis (RDW above 14%) or lymphopenia (ALC level under 1.2x109/L) had greater subsequent all-cause mortality, even after adjusting for age, TE score, and comorbidities. TE score, and to a modest degree RDW, were associated with subsequent liver-associated mortality, while TE score, RDW, and ALC were each independently associated with non-liver cause of death. Conclusion: Widely available mortality calculators generally require multiple pieces of clinical information. RDW and ALC, parameters collected on a single laboratory test that is commonly performed, prior to HCV therapy may be pragmatic markers of long-term risk of mortality.

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High Red Cell Distribution Width Independently Predicts Adverse Survival in Patients with Newly Diagnosed Skull Base Chordoma

OncoTargets and Therapy ◽

10.2147/ott.s335454 ◽

2021 ◽

Vol Volume 14 ◽

pp. 5435-5445

Author(s):

Mingxuan Li ◽

Yutao Shen ◽

Yujia Xiong ◽

Jiwei Bai ◽

Shuai Wang ◽

...

Keyword(s):

Skull Base ◽

Red Cell Distribution Width ◽

Red Cell ◽

Cell Distribution ◽

Newly Diagnosed ◽

Distribution Width ◽

Skull Base Chordoma

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Hematologic variables and venous thrombosis: red cell distribution width and blood monocyte count are associated with an increased risk

Haematologica ◽

10.3324/haematol.2013.083840 ◽

2013 ◽

Vol 99 (1) ◽

pp. 194-200 ◽

Cited By ~ 51

Author(s):

S. M. Rezende ◽

W. M. Lijfering ◽

F. R. Rosendaal ◽

S. C. Cannegieter

Keyword(s):

Venous Thrombosis ◽

Red Cell Distribution Width ◽

Blood Monocyte ◽

Monocyte Count ◽

Red Cell ◽

Cell Distribution ◽

Distribution Width ◽

Increased Risk

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Association of elevated red cell distribution width and overall survival in multiple myeloma.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.8534 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 8534-8534

Author(s):

Sam Rubinstein ◽

Elizabeth Sigworth ◽

Qingxia M Chen ◽

Sandip Chaugai ◽

Robert F. Cornell ◽

...

Keyword(s):

Multiple Myeloma ◽

Overall Survival ◽

Complete Blood Count ◽

Staging System ◽

Cox Proportional Hazards Model ◽

Red Cell Distribution Width ◽

Mechanistic Study ◽

Red Cell ◽

Cell Distribution ◽

Distribution Width

8534 Background: The most widely used multiple myeloma (MM) staging system, the Revised International Staging System (R-ISS), is based on lactate dehydrogenase, albumin, cytogenetics, and beta-2 microglobulin (B2M). B2M has limited clinical utility, is often only obtained to compute R-ISS, and is often a send-out test. Prior studies have shown that elevated red cell distribution width (RDW), a common test that is part of the routine complete blood count, is associated with reduced overall survival (OS) in MM. We hypothesized that a MM staging system could be constructed replacing B2M with RDW. Methods: Patients treated at Vanderbilt University Medical Center from 2000 to 2018 with cancer registry-confirmed MM diagnoses were included. OS was computed by registry-curated death and diagnosis dates; living patients were censored at date last known alive or of last follow up. A Cox proportional hazards model determining the independent effects of R-ISS, age, and RDW on OS was built. An alternate staging system (RDW-SS) was developed, replacing the B2M cutoffs in R-ISS with RDW (stage 1: RDW < 14.0% stage 2: RDW 14.0-15.5%; stage 3: RDW > 15.5%). Cox models comparing RDW-SS and R-ISS after adjustment for age and category of induction therapy (proteasome inhibitor [PI] and immunomodulatory drug [IMiD]), PI only, IMiD only, other) were built. Results: In 604 MM patients with available data, RDW was independently associated with OS after adjustment (HR = 1.069 per 1% RDW increase, p < 0.001). RDW-SS stages were associated with reduced OS (RDW-SS 2 HR 1.52, 95% CI 1.09 – 2.11, p = 0.01; RDW-SS 3 HR 2.13, 95% CI 1.37 – 3.28, p < 0.001) after adjustment; R-ISS stages were not (Table). Conclusions: RDW at MM diagnosis was independently associated with reduced OS, after adjustment for the clinical factors of age and treatment exposure; notably, R-ISS was not. The RDW-SS is simpler to obtain than R-ISS and may have improved prognostic value pending independent validation. If confirmed, mechanistic study of the etiology of this relationship is warranted. [Table: see text]

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