Assessment of the Prognostic Role of Platelets-Lymphocytes and Neutrophil- Monocyte Ratios in Chronic Lymphocytic Leukemia

Background: The most prevalent form of leukemia in the western world is 
chronic lymphocytic leukemia (CLL). Today, there is a lot of worry over the 
evaluation of the platelets-lymphocytes and neutrophil-monocyte ratios in CLL.
Aim of work: To assess platelet –lymphocyte ratio (PLR), neutrophil- monocyte 
ratio (NMR), neutrophil –lymphocyte ratio (NLR) and lymphocyte –monocyte 
ratio (LMR) as biomarkers for CLL prognosis and to evaluate the correlation of 
theses parameters with other established prognostic factors as CD38 and ZAP70 
and their correlation with survival outcome of patients with CLL.
Methods: This retrospective study was conducted at medical oncology and 
clinical pathology departments at south Egypt cancer institute during the period 
from 2010 to 2020. A total of 142 consecutive CLL patients who admitted to 
SECI. Of these, only 90 CLL patients had full data, so they were enrolled in the 
current study. We collected patients’ data at diagnosis and after finishing 
treatment (after three months). The collected data include laboratory data 
(Complete blood picture, liver function, kidney function, Lactate dehydrogenase
and immunophenotyping), clinical data (history and complete clinical 
examination), imaging data (abdominal ultrasound and Compturized 
tomography) and outcome data. 
Results: Regarding immunophenotyping all patients showed co-expression of 
CD5, CD19 and CD23. Also, CD200 was expressed in 94.9% of CLL patients, 
ZAP70 was expressed in 33.3% of CLL patients, CD38 was expressed in 
60.7%, 35.4% of CLL patients had Kappa light chain restriction while 60.4% 
had Lambda light chain restriction. The studied CLL cases have significantly 
lower PLR, NMR, and NLR levels and higher LMR level than that of matched 
controls. After three months of treatment, PLR, NMR, and NLR biomarkers 
levels were significantly increased and LMR was decreased.
Conclusion: At the time of diagnosis, patients with CLL have abnormal 
haematological biomarkers (PLR, NMR, NLR, and LMR), which are 
normalized by treatment. In CLL patients, increased PLR, NMR, and NLR play 
a positive predictive impact.