Highlighting the changes of the Lymphocyte-to-Monocyte ratio in B-cell non-Hodgkin Lymphoma with the treatment and its association with the FLT3/FLT3LG system.

BACKGROUND

B-cell Non-Hodgkin Lymphoma (B-NHL) is a group of lymphoid malignancies characterized by dysregulation of lymphocytes and monocytes. CD135/FLT3 (FMS-like tyrosine kinase 3) and its ligand (FLT3LG) play crucial roles in white blood cell (WBC) proliferation, and their ratios are meaningful indicators of treatment response.

METHODS

The study involved three groups: pre-treatment BNHL (n = 50), post-treatment BNHL (n = 50), and Healthy controls (n = 50). Peripheral blood specimens were analyzed to detect FLT3/CD135 expression using flow cytometry, plasma-FLT3LG by ELISA, and WBC ratios.

RESULTS

Post-treatment and Healthy groups showed FLT3Low expression, whereas 22% of the Pre-treatment group showed FLT3High expression in a subset of 11b+ cells in the monocytic region. Therefore, the pre-treatment-BNHL was divided into Pre-FLT3High and Pre-FLT3Low groups for comparison. Significantly higher (p < 0.05) Neutrophil-to-Lymphocyte (NLR): 24.25 ± 22.39, Neutrophil-to-Monocyte (NMR): 25.12 ± 21.22, and Platelet-to-Lymphocyte (PLR): 875.93 ± 1261.49, and significantly lower (p < 0.05) Lymphocyte-to-Monocyte (LMR): 2.37 ± 2.74, Mean plasma-FLT3LG (25.26 ± 15.35 pg/mL), and a negative correlation between FLT3LG and PLR by Spearman analysis were observed as key differences in the Pre-FLT3High group than others. ROC analysis showed higher AUCs: 0.810 for NLR, 0.733 for LMR, and 0.713 for PLR, discriminating the whole Pre-treatment-BNHL population from healthy controls. Accordingly, the overall model quality values for NLR (0.721) and LMR (0.690) were the best predictors for differentiating Pre-treatment-BNHL from Healthy.

CONCLUSION

NLR and LMR were good predictors for distinguishing Pre-treatment-BNHL from Healthy. The Pre-FLT3High group showed more pronounced deviations in WBC ratios and FLT3LG levels than the other groups. Further studies are warranted to explore the clinical effect of FLT3High 11b + monocytic cells in B-NHL.