Correlation of neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR) with r-chop therapy response in diffuse large B-cell lymphoma (DLBCL) patients
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Putu Niken Ayu Amrita 1 2 3 , Siprianus Ugroseno Yudho Bintoro 2 3 * , I Dewa Gede Ugrasena 4 5 , Ifan Ali Wafa 6 , Nando Reza Pratama 6 , David Setyo Budi 6
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1 Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga, INDONESIA2 Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, INDONESIA3 Department of Internal Medicine, Dr Soetomo General Academic Hospital, Surabaya, INDONESIA4 Department of Child Health, Faculty of Medicine, Universitas Airlangga, INDONESIA5 Department of Child Health, Dr Soetomo General Academic Hospital, Surabaya, INDONESIA6 Faculty of Medicine, Universitas Airlangga, INDONESIA* Corresponding Author

Abstract

Background: The exploration of simple, cost-effective, and low-risk prognostic markers, such as the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) as predictive factors for survival in diffuse large B-cell lymphoma (DLBCL) patients receiving R-CHOP therapy has become increasingly important due to the variability in results seen in prior studies.
Methods: This observational cross-sectional study analyzed NLR, LMR, and PLR as predictors of survival in DLBCL patients treated with R-CHOP. Data was collected from DLBCL patients from June 2017 to June 2022. All statistical analyses were performed using R version 4.2.3 using pROC package for receiver-operating characteristic curves analyses. Univariate and multivariate logistic regression analyses were performed to assess predictors’ association with overall survival (OS).
Results: There were 112 DLBCL patients receiving R-CHOP, 87 were classified as surviving, while 25 were not. Univariate logistic regression analyses revealed significant associations between overall survival (OS) and IPI scores (p < 0.001). Conversely, gender, response to R-CHOP therapy, and hematologic indicators of NLR > 2.0, PLR > 213.4, and LMR > 1.1 did not show significant associations with OS. Multivariable logistic regression analysis using backward selection identified LMR (p = 0.036; 0.24 (95%CI: 0.05 to 0.84) as independent predictors for OS in DLBCL patients.
Conclusions: Our study revealed several fundamental risk factors, including extranodal involvement, ECOG performance status, LDH, and LMR, were independently associated with 2-year mortality in DLBCL patients before initiating R-CHOP therapy. However, due to the limitations of this study, further research with larger sample sizes is warranted.

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Article Type: Original Article

ELECTRON J GEN MED, Volume 23, Issue 2, April 2026, Article No: em720

https://doi.org/10.29333/ejgm/18079

Publication date: 11 Mar 2026

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Article Downloads: 2

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