Myelofibrosis: Neutrophil-to-lymphocyte ratio impact on prognosis and discontinuation of ruxolitinib

Neutrophil-to-lymphocyte ratio (NLR) is a reliable biomarker for survival in many diseases.¹ Ruxolitinib, a first-in-class Janus kinase 1/2 inhibitor, is used successfully in treating patients with myelofibrosis (MF); however, the impact on overall survival (OS) vs best available therapy varies between patients.

Here, we summarize a retrospective study published by Laganà et al.² in European Journal of Haematology on the use of NLR as a biomarker for OS in patients with MF treated with ruxolitinib.

Study design²

• Single center study in patients with chronic primary MF or secondary MF.
• Baseline NLR was recorded, and patients were evaluated every 3 months until treatment cessation, and 6 months after treatment cessation.
• Endpoints assessed included NLR correlation with complete spleen response and OS.

Key findings²

• Included 140 patients:
  • 47% were male;
  • 25% had secondary MF rising from polycythemia vera and 29% after essential thrombocythemia; and
  • 70% had Janus kinase 2 mutated-MF and 11% had calreticulin-MF.
• After 36.2 months median follow-up:
  • 60% achieved complete spleen response after a median of 8.22 months; however, baseline NLR was not a predictor of spleen response (p = 0.151); and
  • NLR was found to predict OS with patients having a baseline NLR ≥2 reporting a longer OS than patients with NLR <2.
• Median OS was 32.5 months, and 31 deaths were reported
  • The two main causes of death were acute myeloid leukemia progression (41.9%) and infections (41.9%)
• Discontinuation was reported in 41.4% (Figure 1).
• Patients who discontinued treatment earliest for any reason except allogeneic transplantation had a baseline NLR <2 compared with NLR ≥2 (27.7 months vs not reached, respectively).

Figure 1. Causes of discontinuation in patients with chronic primary or secondary MF*

AML, acute myeloid leukemia; MF, myelofibrosis.
*Adapted from Laganà, et al.¹