Neutrophil to Lymphocyte Ratio - Not an Independent Prognostic Factor in Patients with the Myelodysplastic Syndrome

  • Akinci, Sema (Department of Hematology, Ankara Ataturk Training and Research Hospital) ;
  • Silay, Kamile (Department of Geriatrics, Yildirim Beyazit University) ;
  • Ulas, Arife (Department of Oncology, Yildirim Beyazit University) ;
  • Guney, Tekin (Department of Hematology, Ankara Ataturk Training and Research Hospital) ;
  • Hacibekiroglu, Tuba (Department of Hematology, Ankara Ataturk Training and Research Hospital) ;
  • Basturk, Abdulkadir (Department of Hematology, Ankara Ataturk Training and Research Hospital) ;
  • Akinci, Muhammed Bulent (Department of Oncology, Yildirim Beyazit University) ;
  • Alkan, Afra (Department of Biostatistics, Yildirim Beyazit University) ;
  • Dilek, Imdat (Department of Hematology, Yildirim Beyazit University)
  • Published : 2015.01.22


Purpose: Neutrophil-to-lymphocyte ratio (NLR) was evaluated as a potential prognostic factor in patients with myelodysplastic syndrome (MDS). Materials and Methods: Between December 2009 and April 2014, 14 female (35%) and 26 male (65%) MDS patients who were followed up in our hematology clinic were included in the study for NLR during diagnosis. Division was into two groups according to the NLR, and the correlation with mortality was evaluated. The prognostic significance of NLR regarding treatment outcome was also evaluated with adjustment for known confounding risk factors. Results: The mortality rate of the patient group was 55%, and median survival was 18 months. There was no significant correlation between mortality and NLR at a median value of 1.8 (p=0.75). Thrombocytopenia was observed to increase mortality (p=0.027), and there was a significant correlation between mortality and pancytopenia (p=0.017). Conclusions: This first study of NLR and mortality did not show any significant correlation. In centres with limited access to genetic evaluation for the presence of pancytopenia and/or thrombocytopenia at the time of diagnosis, a platelet level less than $50{\times}10^9/l$ may be poor prognostic markers in MDS patients.


  1. Bejar R (2013). Prognostic models in myelodysplastic syndromes. Hematology Am Soc Hematol Educ Program, 2013, 504-10.
  2. Breccia M, Latagliata R, Cannella L, et al (2010). Refractory cytopenia with unilineage dysplasia: analysis of prognostic factors and survival in 126 patients. Leuk Lymphoma, 51,783.
  3. Buesche G, Teoman H, Wilczak W, et al (2008). Marrow fibrosis predicts early fatal marrow failure in patients with myelodysplastic syndromes. Leukemia, 22, 313.
  4. Chen YD, Xu ZF, Cui R, et al (2012). A preliminary study of prognostic value of thrombocytopenia in patients with primary myelodysplastic syndromes. Zhonghua Xue Ye Xue Za Zhi, 33, 532-5.
  5. -Della Porta MG, Malcovati L, Strupp C, et al (2011). Risk stratification based on both disease status and extrahematologic comorbidities in patients with myelodysplastic syndrome. Haematologica, 96, 441-9.
  6. Foran JM, Shammo JM (2012). Clinical presentation, diagnosis, and prognosis of myelodysplastic syndromes. Am J Med, 125, 6-13.
  7. Greenberg PL, Tuechler H, Schanz J, et al (2012). Revised international prognostic scoring system for myelodysplastic syndromes. Blood, 120, 2454-65.
  8. Gonzalez-Porras JR, Cordoba I, Such E, et al (2011). Prognostic impact of severe thrombocytopenia in low-risk myelodysplastic syndrome. Cancer, 117, 5529.
  9. He WZ, Jiang C, Yin CX, et al (2014). Prognostic model built on blood-based biomarkers in patients with metastatic colorectal cancer. Asian Pac J Cancer Prev, 15, 7327-31.
  10. Kantarjian H, O'Brien S, Ravandi F, et al (2008). Proposal for a new risk model in myelodysplastic syndrome that accounts for events not considered in the original International Prognostic Scoring System. Cancer, 113, 1351.
  11. Kelkitli E, Atay H, Cilingir F, et al (2013). Predicting survival for multiple myeloma patients using baseline neutrophil/ lymphocyte ratio. Ann Hematol, 93, 841-6.
  12. Kemal Y, Yucel I, Ekiz K, et al (2014). Elevated serum neutrophil to lymphocyte and platelet to lymphocyte ratios could be useful in lung cancer diagnosis. Asian Pac J Cancer Prev, 15, 2651-4.
  13. Kim JY, Park T, Jeong SH, et al (2013). Prognostic importance of baseline neutrophil to lymphocyte ratio in patients with advanced papillary thyroid carcinomas. Endocrine, 46, 526-31.
  14. Mittelman M, Oster HS, Hoffman M, and Neumann D (2010). The lower risk MDS patient at risk of rapid progression. Leuk Res, 34, 1551-5.
  15. Parnes A, Nikiforow S, Berliner N, Vanasse GJ (2010). Single nucleotide polymorphisms in the human TNF gene are associated with anaemia and neutropenia in a cohort of patients with de novo myelodysplastic syndrome. Br J Haematol, 150, 700.
  16. Thiele J, Kvasnicka HM, Facchetti F, et al (2005). European consensus on grading bone marrow fibrosis and assessment of cellularity. Haematologica, 90, 1128.
  17. Troppan K, Deutsch A, Gerger A, et al (2014). The derived neutrophil to lymphocyte ratio is an independent prognostic factor in patients with diffuse large B-cell lymphoma. Br J Cancer, 110, 369-74.
  18. Wang R, Gross CP, Halene S, Ma X (2009). Comorbidities and survival in a large cohort of patients with newly diagnosed myelodysplastic syndromes. Leuk Res, 33, 1594-1598.