Background and purpose: The prognostic capability of traditional prognostic index like follicular lymphoma international prognostic index (FLIPI) is limited in the rituximab era. This study was to investigate the prognostic significance of peripheral blood absolute lymphocyte count/absolute monocyte count (ALC/AMC) in Chinese patients with follicular lymphoma (FL). Methods: This study retrospectively analyzed 136 newly diagnosed FL patients who received rituximab plus cyclophosphamide

doxorubicin

vincristine and prednisone (R-CHOP)-like chemotherapy in Department of Hematology

Ruijin Hospital from Jan. 2003 to Dec. 2013

and further classified these patients according to FLIPI scoring system. Results: According to FLIPI

61 patients (44.9%) were stratified into the low-risk (0-1 points) group

42 cases (30.9%) into the intermediate-risk (2 points) group

and 33 cases (24.2%) into the high-risk (3-5 points) group. The overall response rate and 2-year progression-free survival (PFS) of the 3 risk groups were 88.5%

95.2%

and 78.8% (P=0.090)

and 91.4%

74.6%

and 47.8% (log-rank=23.3，P0.001)

respectively. The overall response rate and 2-year PFS for patients with ALC/AMC≥4.7 and 4.7 were 91.9%

68.6% (P=0.005) and 96.0%

69.7% (log-rank=13.0

P0.001)

respectively. In the multivariate study

ALC/AMC≥4.7 was independent of FLIPI and was able to distinguish the FLIPI low-risk and intermediate-risk patients (log-rank=7.535

P=0.006). Conclusion: For FL patients treated with R-CHOPlike regimens

ALC/AMC is a simple and effective biomarker reflecting tumor microenvironment and human immunity

and could be considered for prognosis evaluation.