Back in June, I posted this: Lab values that may predict response to ipi/Yervoy The article discussed baseline neutrophil-to-lymphocyte ratios specifically. Here is an expanded study by the same lead author.
Baseline neutrophils and derived
neutrophil-to-lymphocyte ratio: prognostic relevance in metastatic melanoma
patients receiving ipilimumab. Ferrucci, Ascierto, Pigozzo, et al. Ann Oncol. 2016 Jan 22.
"Clinical responses to
ipilimumab are variable in terms of onset, magnitude and duration. Upfront
identification of patients who are more likely or unlikely to benefit from
treatment is a major need.
Prospectively collected data
from 720 advanced melanoma patients treated with ipilimumab 3 mg/kg within the
Italian expanded access programme were analyzed. The derived neutrophil-to-lymphocyte
ratio (dNLR) was calculated from baseline peripheral blood cell counts, and
receiver operating characteristic curve was used to evaluate the best cut-off
for this marker. Patients were stratified according to dichotomized baseline
absolute neutrophil counts (ANC), dNLR, and their combination. The prognostic
values of ANC and dNLR for survival were assessed using multivariate Cox
proportional hazard models. A subgroup analysis including LDH in the models was
also performed.
The median follow-up was 16.5
months. The optimal cut-off for dNLR was 3.
Baseline ANC and dNLR were
significantly associated with outcome of ipilimumab-treated melanoma patients,
in terms of disease progression and death. Further, for
each elevated variable, prognosis worsened. Patients with both ANC≥7500 and
dNLR≥3 had a significantly and independently increased risk of death and of progression compared to
patients with both lower ANC and dNLR. Patients with one of the two factors
elevated displayed an intermediate risk of progression and death. The 1-year
and 2-years survival rates were 2% and 0%, respectively, for patients with
ANC≥7500 and dNLR≥3, and 43% and 24%, respectively, for patients with both
lower ANC and dNLR."
So....elevated absolute neutrophil counts as well as elevated neutrophil-to-lymphocyte ratios did not bode well for the 720 melanoma patients treated with ipi in this study. The risk for progression and death was even greater when both of those values were increased. This report is consistent with the findings from the initial, smaller study of 214 melanoma patients treated with ipi in which: "Patients with baseline NLR (neutrophil-to-lymphocyte ratio) less than 5, had a significantly improved progression free survival and overall survival compared to those with a NLR equal or greater than 5."
For what it's worth....c
Interesting. Depending on when you pick your baseline... I just ran all my husband's ANC and ALC data and when he was in crisis, pre-chemo, the dNLR was as high as 15.5. Two months later when he started ipi, it was 2.2. Ipi also happened not to work for him. For what it's worth. :)
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I presume from the way "baseline" is used in this study...it would mean pretreatment (of any sort) levels...but it is not terribly clear and presents even more confusion for those like your husband who undergo sequential treatments. Wishing you both my best.
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