{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T14:03:24Z","timestamp":1789653804798,"version":"4.0.0"},"reference-count":42,"publisher":"Wiley","issue":"17","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Laboratory Analysis"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The tumor microenvironment drives pathogenesis and drug resistance in multiple myeloma (MM), while the R\u2010ISS does not capture host immune status. We investigated whether simple systemic inflammation markers\u2014neutrophil\u2010to\u2010lymphocyte ratio, monocyte\u2010to\u2010lymphocyte ratio, and platelet\u2010to\u2010lymphocyte ratio\u2014could improve prognostic assessment and identify high\u2010risk patients among newly diagnosed MM patients treated with novel agents in a retrospective cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a single\u2010center retrospective analysis of 268 newly diagnosed MM patients between January 2019 and December 2023. Optimal cut\u2010off values were determined using Receiver Operating Characteristic (ROC) curve analysis. The primary endpoints were Overall Survival (OS) and Progression\u2010Free Survival (PFS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The optimal cut\u2010off values were determined as 2.85 for NLR, 0.34 for MLR, and 142.5 for PLR. Elevated NLR and MLR were significantly correlated with advanced R\u2010ISS stage (III), anemia, and high beta\u20102 microglobulin (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Kaplan\u2013Meier analysis showed that patients with high NLR and MLR had significantly inferior OS and PFS. In the multivariate Cox regression model adjusted for cytogenetic risk and post\u2010induction ASCT, high NLR (HR\u2009=\u20091.84, 95% CI: 1.22\u20132.78,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004) and high MLR (HR\u2009=\u20091.65, 95% CI: 1.10\u20132.48,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.015) remained independent prognostic factors. PLR was not significant in multivariate analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Pretreatment NLR and MLR are robust, cost\u2010effective prognostic biomarkers in MM that retain their independent predictive value even after adjusting for the R\u2010ISS and intensive post\u2010induction therapies such as ASCT. They reflect the immunosuppressive TME and may significantly refine the current staging system to identify high\u2010risk patients who might require earlier immune\u2010bridging interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jcla.70308","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:53:59Z","timestamp":1787032439000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic Significance of Peripheral Blood Neutrophil\u2010To\u2010Lymphocyte Ratio (\n                    <scp>NLR<\/scp>\n                    ), Monocyte\u2010To\u2010Lymphocyte Ratio (\n                    <scp>MLR<\/scp>\n                    ), and Platelet\u2010To\u2010Lymphocyte Ratio (\n                    <scp>PLR<\/scp>\n                    ) in Patients With Multiple Myeloma: A Retrospective Cohort Study"],"prefix":"10.1002","volume":"40","author":[{"given":"Lihong","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Hematology The First Hospital of Hebei Medical University  Shijiazhuang Hebei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4163-2821","authenticated-orcid":false,"given":"Bing","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Hematology The First Hospital of Hebei Medical University  Shijiazhuang Hebei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7529-116X","authenticated-orcid":false,"given":"Jingyu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Hematology The Second Hospital of Hebei Medical University  Shijiazhuang Hebei China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2017.46"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.61.2267"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI129205"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1158\/2159-8290.CD-21-1059"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms26136177"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2010.01.025"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.925266"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00432-023-05315-8"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41388-023-02781-9"},{"issue":"2","key":"e_1_2_14_11_1","first-page":"S4","article-title":"The Immune System in Multiple Myeloma and Precursor States: Lessons and Implications for Immunotherapy and Interception","volume":"98","author":"Dhodapkar M. 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