Original Study Prognostic Significance of Absolute Lymphocyte Count, Absolute Monocyte Count, and Absolute Lymphocyte Count to Absolute Monocyte Count Ratio in Follicular Non-Hodgkin Lymphoma Asmaa Mohsen, 1 Mona Taalab, 1 Nashawa Abousamra, 2 Mohamed Mabed 1 Abstract Evaluation of the impact of baseline absolute lymphocyte count, absolute monocyte count, and the lympho- cyte/monocyte ratio, on the treatment response and prognosis in 100 patients with follicular lymphoma were presented. The study showed that absolute lymphocyte count, absolute monocyte count, and the lymphocyte/ monocyte ratio at diagnosis are simple indices, which reflect the host systemic immunity and can predict the clinical outcomes in follicular lymphoma. Introduction: Recently, the lymphocyte to monocyte ratio (LMR) has been proposed as an easily determinable prognostic factor in patients with cancer, including lymphomas. The objective of this study was the evaluation of the impact of baseline absolute lymphocyte count (ALC), absolute monocyte count (AMC), and the LMR on the treatment response and prognosis in follicular lymphoma (FL). Patients and Methods: The data of 100 patients with a FL variant, admitted and treated between January 2009 and June 2018, were analyzed. Results: The area under the receiver operator characteristic curve and cutoff values of ALC, AMC, and LMR for discrimination between survival times using receiver operating characteristic curves showed 0.57  10 9 /L as the most discriminative ALC cutoff value, 1.235 10 9 / L as the most discriminative AMC cutoff value, and 1.63 as the most discriminative LMR cutoff value. Progressive disease and stable disease after first-line therapy and mortality rate were significantly associated with lower ALC, higher AMC, and higher LMR. Shorter overall survival (OS) was significantly associated with patients with lower ALC when compared with those having higher ALC. Shorter OS and progression-free survival (PFS) were significantly associated with higher AMC when compared with those having lower AMC. Shorter OS and PFS were significantly associated with lower LMR when compared with those having higher LMR. High-risk Follicular Lymphoma Interna- tional Prognostic Index as well as low LMR were considered as risk factors for prediction of OS in all the studied patients with FL in univariate analysis and multivariate analysis. Conclusion: ALC, AMC, and LMR at diagnosis are simple indices, which reflect the host systemic immunity and can predict the clinical outcomes in FL. Clinical Lymphoma, Myeloma & Leukemia, Vol. -, No. -, --- ª 2020 Elsevier Inc. All rights reserved. Keywords: Absolute lymphocyte count, Absolute monocyte count, Follicular lymphoma, Lymphocyte/monocyte ratio, Prognosis Introduction Follicular lymphoma (FL) has a heterogeneous nature. Some patients develop progression early, whereas others survive for decades without requiring treatment. Hence, effective prognostic indices are needed to help physicians to select appropriate therapies and to design effective clinical trials. The Follicular Lymphoma International Prognostic Index (FLIPI) and the Follicular Lymphoma International Prognostic Index 2 (FLIPI2) are well-known prognostic indices of the baseline characteristics of FL diagnosis. 1,2 1 Clinical Hematology Unit, Internal Medicine Department 2 Clinical Pathology Department, Hematology Unit, Faculty of Medicine, Oncology Center, Mansoura University, Mansoura, Egypt Submitted: Jan 27, 2020; Revised: Mar 12, 2020; Accepted: Mar 14, 2020 Address for correspondence: Mohamed Mabed, MD, PhD, The Hematology Unit, Oncology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt E-mail contact: mohmabed@mans.edu.eg 2152-2650/$ - see frontmatter ª 2020 Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.clml.2020.03.007 Clinical Lymphoma, Myeloma & Leukemia Month 2020 - 1