Büşra Tuğçe TONYALI, Deniz ARICA, Ebru KOCA, Sema KARAKUŞ, Şahika Zeynep AKI
Acta Haematologica Oncologica Turcica - 2026;59(2):156-162
Aim: Neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) are inflammatory markers that have been studied as prognostic factors in diffuse large B-cell lymphoma (DLBCL). However, the prognostic value of these markers in elderly patients is unclear. Methods: A retrospective analysis was conducted on 82 de novo DLBCL patients aged >=65 years who received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or R-CHOP-like treatment. Kaplan-Meier and Cox regression analyses were used to evaluate overall survival (OS) and progression-free survival (PFS). The discriminatory power of NLR and LMR was examined using receiver operating characteristic (ROC) analysis. Restricted cubic spline analysis was used to evaluate possible nonlinear associations between these biomarkers and survival. Results: The median follow-up time was 35.5 months. Analyses based on median values showed no significant association between NLR and LMR and OS and PFS. In ROC analysis, both NLR [area under the curve (AUC): 0.575, p=0.289] and LMR (AUC: 0.517, p=0.815) showed low discriminatory power. Multivariate analysis revealed that NLR was an independent prognostic factor for OS (hazard ratio: 1.11, 95% confidence interval: 1.01-1.22, p=0.032), whereas LMR was not significant. The restricted cubic spline analysis did not reveal a significant nonlinear association or a threshold effect between NLR and survival outcomes. Conclusion: Although NLR was statistically associated with OS when analyzed as a continuous variable, no distinct threshold value was identified. These results show that, in older DLBCL patients, NLR may function as a weak, continuous biomarker rather than as a clinically significant risk indicator.
