The albumin-to-fibrinogen ratio (AFR) at diagnosis may be predictive of poor outcomes among patients with untreated chronic lymphocytic leukemia (CLL), according to a study published in Cancer Research and Treatment.1

Low albumin and high fibrinogen are indicators of nutrition and inflammation and have been associated with poor outcomes in various diseases, including CLL. Previous studies have shown that AFR, a novel immune biomarker, may predict poor outcomes in non-small cell cancer but its ability to determine the prognosis of patients with CLL has not been investigated.

For this retrospective study, researchers evaluated the outcomes of 191 patients with treatment-naive CLL. Assessed patients had evaluable laboratory measurements from within 24 hours after first admission, including absolute lymphocyte and platelet counts, hemoglobin, serum albumin, fibrinogen, and mutational status.

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The AFR cut-off point was set at 9.7, and the median AFR was 17.19 at diagnosis. Older patients greater than 65 years had a low AFR more commonly compared with younger patients. Overall, 20 patients had low AFR (≤ 9.7) compared with 171 patients who had high AFR (> 9.7).

Results showed that patients with a low AFR had significantly reduced overall survival (OS) compared with patients who had a high AFR (P < .001). The 3-year OS rate was 56.1% and 92.8% in the low and high groups, respectively, and the 5-year OS rate was 56.1% and 82.4%, respectively. No significant differences in treatment-free survival, however, were observed between the 2 groups.

A multivariate analysis revealed that AFR was a significant, negative independent prognostic factor for OS (P = .003), and was associated with worse outcomes regardless of any other adverse prognostic or clinical factors observed in patients.

The authors concluded that “further researches containing a larger population and multicenter data are needed to better understand the roles of AFR level in CLL.”


  1. Zou YX, Qiao J, Zhu HY, et al. Albumin-to-fibrinogen ratio as an independent prognostic parameter in untreated chronic lymphocytic leukemia: a retrospective study of 191 cases [published online August 1, 2018]. Cancer Res Treat. doi: 10.4143/crt.2018.358