Body mass index as a prognostic factor in Asian patients treated with chemoimmunotherapy for diffuse large B cell lymphoma, not otherwise specified

Abstract

Obesity was recently reported to confer a survival advantage in diffuse large B cell lymphoma (DLBCL) among Western populations. Given ethnic differences, previous studies recommended a revision of the WHO classification of obesity for Asians. We investigated the prognostic impact of body mass index (BMI) using modified WHO criteria in a retrospective cohort of 562 Korean patients with DLBCL. Patients were categorized into five groups according to BMI: 26 (4.6 %) as underweight (<18.5 kg/m(2)), 230 (40.9 %) as normal weight (18.5-22.9 kg/m(2)), 129 (23.0 %) as overweight (23.0-24.9 kg/m(2)), 160 (28.5 %) as obese (25.0-29.9 kg/m(2)), and 17 (3.0 %) as severely obese (≥30 kg/m(2)). As BMI increased, the relative hazard ratio (HR) decreased sharply, reaching the lowest value in the overweight group, and then rose again in the obese and severely obese. On univariate analysis, both overall survival (OS) and progression-free survival (PFS) were best in the overweight group, followed by normal > obese > severely obese > underweight groups. Multivariate analysis showed a significantly shorter survival in the underweight (OS: HR 2.90, 95 % confidence interval (CI) 1.35-6.19, P = 0.006; PFS: HR 3.08, 95 % CI 1.55-6.09, P = 0.001) and severely obese groups (OS: HR 2.93, 95 % CI 1.08-7.95, P = 0.035; PFS: HR 2.59, 95 % CI 1.06-6.36, P = 0.038). We show that being underweight or, contrary to findings in Western patients, being severely obese has a deleterious prognostic impact in DLBCL in Koreans. Revising the BMI criterion that defines obesity according to the patient's ethnic differences could therefore better delineate DLBCL risk groups in Asian patients.

Increased body mass index is associated with improved overall survival in extranodal natural killer/T-cell lymphoma, nasal type

“…Hwang et al found that being underweight or severely obese has a deleterious prognostic impact in DLBCL [25]. Consistent with the findings of several previous studies [6–10], we found that higher BMI is an independent prognostic factor for longer PFS and OS.…”

“…Most authors have used the WHO classification of obesity to distinguish between BMI groups [7, 13, 25, 26]. In contrast, Park et al [9] and Weiss et al [10] used dichotomized classification schemes with cutoffs of 20.0 and 25.0 kg/m 2 , respectively.…”

Prognostic Value of the Pretreatment Advanced Lung Cancer Inflammation Index (ALI) in Diffuse Large B Cell Lymphoma Patients Treated with R-CHOP Chemotherapy

“…Kim et al [35 ]reported that modified GPS score (based on CRP and serum albumin) is a potential prognostic factor in DLBCL, and Porrata et al [39 ]found that a peripheral blood absolute lymphocyte/monocyte ratio of <1.1 during treatment independently predicted inferior OS and PFS. Others have reported that BMI is a favorable prognostic factor in DLBCL [40,41]. These findings, if confirmed by larger studies, will provide additional information on the enhancement of treatment response and survival in a large proportion of DLBCL patients.…”

A new extranodal scoring system based on the prognostically relevant extranodal sites in diffuse large B-cell lymphoma, not otherwise specified treated with chemoimmunotherapy

“…Patient characteristics were similar to those used in our previously published article [6]. Our study cohort comprised 1021 patients with DLBCL who were treated with rituximab-based chemoimmunotherapy regimens, between January 2002 and March 2014.…”