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There are contradictory results of earlier studies regarding the impact of body mass index (BMI) on overall survival (OS) or progression-free survival (PFS) of diffuse large B cell lymphoma (DLCLB). Many factors like drug distribution and drug metabolism might influence the outcome in patients with excess body weight. The best method to predict outcome and adjust therapeutic approach is not known and elderly DLCLB patients do not always receive the appropriate therapeutic regimen.

To evaluate if BMI at diagnosis can predict clinical outcome in older patients with DLCLB receiving the first– line chemotherapy.

Patients at the Institution for Oncology and radiology of Serbia between 2005 and 2015 who were diagnosed and received first-line chemotherapy for DLCLB, older than 65 years were enrolled. Clinical and treatment data were recorded including BMI at the diagnosis. Patients were stratified into BMI groups according to WHO guidelines: underweight (BMI<18.5kg/m² ), normal weight (BMI 18.5 to<25kg/m²), overweight (BMI 25 to<30kg/m²), obesity class I (BMI 30 to<35kg/m²). Survival time was estimated using the Kaplan- Meier (KM) method, and Cox proportional hazard model was used to evaluate the risk factors significance for survival. A p-value <0.05 was considered significant.

87 patients were included in the study. 23 (26.44%) patients were older than 75 years, 52 (59.77%) were female, 38 (43.67%) were Ann Arbor stage 1 and 2, 28 (32.18%) were International prognostic index (IPI) score 0-1. The majority of patients were diagnosed as normal weigth (39.08%) and overweight (31.03%), less were in obesity class I group (14.94%) and only 2,3% underweight. 38 (43.68%) patients received CHOP, 27 (31.03%) mCHOP, 12 (13.79%) CVP and 10 (11.49%) CEOP regimen, with or without Rituximab. In the whole group, obese patients had shorter OS and PFS. After a median follow-up of 43 months (range, 1-128), median OS times were 19 months (4-not reached) for obese, 54 months (not reached) for underweight, 90 months (53-not reached) for normal weight and not reached for overweight. PFS was 18 months (4-not reached) for obese, 67 (51-not reached) and 91 months (53-not reached) for overweight and normal weight. In the treatment of normal weight and overweight patients, the same chronological age, frequently was used anthracyclin based regimen (CHOP, 27 patients; mCHOP, 22 patients; CVP, 7 patients; CEOP, 7 patients). There was no difference in the frequency of different regimens in obesity group. In the group of patients treated with anthracyclin based regimens, obese patients tended to have shorter survival, the median OS was 33 months (9-not reached), while normal weight patients tended to have a longer OS, the median OS-not reached. The worse survival among non-anthracyclin regimen treated patients, had obese patients, median OS 26 months (9-not reached). Overweight females and men with normal weight exhibited the best median OS and PFS (not reached). In obese patients, females tended to have a longer OS and PFS (median OS/PFS 19/18 months for women versus 9/9 months for men), although the difference was not statistically significant (p=0.77).

Obesity was associated with shorter survival among older patients with DLCLB treated with different chemotherapy regimens. The impact of gender on PFS and OS varied with BMI. The use of anthracyclin did not influence the outcome of obese patients. This study suggests that BMI may predict survival in older patients with newly diagnosed DLCLB.