IBCL-295: Prognostic value of neutrophil-to-lymphocyte ratio in follicular lymphoma: A tertiary care analysis

Abstract

Background: Follicular lymphoma (FL) is the second most common type of indolent non-Hodgkin lymphoma. Despite its generally favorable prognosis, a subset of patients experience early progression or transformation, underscoring the need for accessible prognostic markers. The neutrophil-to-lymphocyte ratio (NLR), a surrogate marker of systemic inflammation, has been investigated in various malignancies; however, its prognostic utility in FL remains unclear, particularly in real-world settings. Objectives: Assess the prognostic value of baseline NLR for overall survival (OS) and progression-free survival (PFS) in patients with FL treated at a tertiary care center. Methods: We conducted a retrospective analysis of 107 patients diagnosed with FL between 2012 and 2023 at a tertiary care center. Baseline NLR was calculated from complete blood counts performed prior to initiation of therapy. Receiver operating characteristic curve analysis was used to evaluate the ability of NLR to predict OS and PFS. The area under the curve (AUC) and optimal NLR cutoff values were determined using Youden’s index. Results: For OS, the NLR had an AUC of 0.538 (95% CI: 0.321–0.754), indicating limited predictive value. The optimal NLR cutoff for OS prediction was 1.605, yielding a sensitivity of 54.5% and a specificity of 70.8%. For PFS, the NLR had an AUC of 0.506 (95% CI: 0.391–0.621), again reflecting poor discrimination. The optimal cutoff was 1.973, with a sensitivity of 63.8% and a specificity of 53.5%. No statistically significant association was observed between NLR and survival outcomes in either univariable or multivariable models. Conclusions: In this real-world cohort of FL patients, baseline NLR showed limited utility in predicting OS or PFS. Larger, prospective studies are needed to further elucidate its value in risk stratification.