Introduction Systemic sclerosis is a complex disease that affects various target organs, making it difficult to assess response and determine remission or relapse. A baseline Neutrophil-to-Lymphocyte Ratio (NLR) >2.95 is associated with severe progressive skin and lung disease and decreased 5-year survival in systemic sclerosis (SSc). However, it is unknown whether NLR changes in response to treatment. Objective To retrospectively evaluate NLR changes as a biomarker for treatment response in SSc. Methods Progressive diffuse SSc patients who were treated with autologous hematopoietic stem cell transplantation (AHSCT group), with combination therapy of rituximab and mycophenolate mofetil (combination group) or CAR-T cell therapy (CAR-T group) were recruited, along with healthy controls (HC group). NLR, modified Rodnan Skin Score (mRSS) and forced vital capacity (FVC)% predicted were repeatedly assessed over 2 years. Results Fifteen patients were recruited in the AHSCT group, 15 in the combination group, and six patients in the CAR-T group. Baseline mean NLR was high (>2.95) in AHSCT, combination groups, and CAR-T compared with HC. All treatment arms showed a statistically significant decrease in mRSS values and an increase in FVC% at each time point up to 12 months. In a linear mixed model, NLR significantly decreased up to 24 months only in the AHSCT group. NLR correlated with mRSS and FVC exclusively in the AHSCT group. NLR increased above 3 in two patients who experienced a relapse after AHSCT. Conclusion NLR is a simple biomarker that correlated with outcome measures in SSc following AHSCT, but not with conventional therapy or CAR-T therapy. It is suggested that a decrease in NLR following AHSCT may indicate remission, whereas an increase may be associated with exacerbation. Further research is needed to validate these novel findings.

中文翻译：

---

中性粒细胞与淋巴细胞比值作为系统性硬化症自体造血干细胞移植后临床反应的生物标志物


简介 系统性硬化症是一种影响各种靶器官的复杂疾病，因此难以评估反应并确定缓解或复发。基线中性粒细胞与淋巴细胞比值 （NLR） >2.95 与严重进行性皮肤和肺部疾病相关，并且系统性硬化症 （SSc） 的 5 年生存率降低。然而，尚不清楚 NLR 是否会因治疗而发生变化。目的 回顾性评价 NLR 变化作为 SSc 治疗反应的生物标志物。方法 纳入接受自体造血干细胞移植治疗 （AHSCT 组） 联合利妥昔单抗与吗替麦考酚酯联合治疗 （联合组） 或 CAR-T 细胞治疗 （CAR-T 组） 进行性弥漫性 SSc 患者，以及健康对照 （HC 组）。在 2 年内重复评估 NLR、改良 Rodnan 皮肤评分 （mRSS） 和用力肺活量 （FVC） % 预测。结果 AHSCT 组招募 15 例患者，联合组 15 例，CAR-T 组 6 例。与 HC 相比，AHSCT 、联合组和 CAR-T 的基线平均 NLR 较高 （>2.95）。所有治疗组均显示 mRSS 值在长达 12 个月的每个时间点均具有统计学意义的降低和 FVC% 的增加。在线性混合模型中，仅在 AHSCT 组中，NLR 在 24 个月内显着降低。NLR 仅在 AHSCT 组中与 mRSS 和 FVC 相关。2 例 AHSCT 后复发的患者 NLR 升高至 3 以上。结论 NLR 是一种简单的生物标志物，与 AHSCT 后 SSc 的结局指标相关，但与常规治疗或 CAR-T 治疗无关。 研究表明，AHSCT 后 NLR 的降低可能表明缓解，而增加可能与恶化有关。需要进一步的研究来验证这些新发现。