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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
References
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