Predictive value of neutrophil-to-lymphocyte, lymphocyte-to-monocyte, and platelet-to-lymphocyte ratios in adult and pediatric acute lymphoblastic leukemia patients

Background Methods used for prognostication of acute lymphoblastic leukemia (ALL) are expensive; discovering low-cost prognostic factors is challenging. Objectives This study aimed to explore the prognostic role of baseline neutrophil-to-lymphocyte (NLR), lymphocyte-to-monocyte (LMR), and platelet-to-lymphocyte (PLR) ratios in predicting the response to end of induction chemotherapy in ALL patients. Patients and methods We included 44 adult patients and 47 pediatric patients who were newly diagnosed with ALL. All participants were subjected to a full history taking and a thorough medical examination. Laboratory investigations included complete blood count (CBC) with differential count analysis, with calculation of NLR, LMR, and PLR; bone marrow examination; conventional cytogenetic analysis; and immunophenotyping. Patients were followed until the end of the induction phase, and their response to treatment was assessed. Results Among the adult patients, 63.6% showed complete remission at the end of induction; their baseline CBC showed significantly lower NLR (P=0.001) and higher LMR (P=0.013). On the other hand, 66% of the pediatric patients showed good response to induction chemotherapy; their baseline CBC showed significantly lower NLR (P<0.001), greater LMR (P=0.0134), and lower PLR (P=0.017). NLR more than or equal to 1, LMR less than or equal to 2.846, and PLR more than or equal to 39.1 were able to discriminate adult patients who will respond to induction chemotherapy, similarly NLR more than or equal to 1, LMR less than or equal to 3.286, and PLR more than or equal to 10 among pediatric patients. Conclusion Our research discovered that the rise in NLR and PLR, together with the decline of LMR at ALL diagnosis, could predict future resistance to the routinely used induction protocols, and the need for intensification regimens.