Background: Neutrophil to lymphocyte ratio was initially used as a low cost prognostic marker in a group of solid tumors and subsequently hypothesized to have a role in multiple myeloma. This retrospective analysis aimed to report the prognostic importance of the neutrophil to lymphocyte ratio in multiple myeloma.Methods: Between November 2003 and February 2016, we included 175 patients from two centers in this study. CBC differentials were primarily checked by a Sysmex analyzer in both centers. In one center, differentials were rechecked by light microscopy. Analysis of survival was performed using a Kaplan-Meier estimate and we assessed the effects of prognostic factors by Cox proportional hazards model.Results: Patients had a mean age of 63.22±10.89 years. Although mean lymphocyte percent did not differ between the two centers, mean neutrophil percent and mean neutrophil to lymphocyte ratio were higher at the center that manually checked the CBC differentials. After adjustments for age and gender, we noted that the hazard ratio for elevated neutrophil to lymphocyte ratio when stratified for the centers was 1.07 (95% CI: 1.01–1.15, P=0.034).Conclusion: A precisely checked neutrophil to lymphocyte ratio could act as a potentially inexpensive, accessible prognostic factor for multiple myeloma patients.