Effect of Nutritional Status on Survival Outcome of Diffuse Large B-Cell Lymphoma Patients Treated with Rituximab-CHOP

Abstract

The impact of pretreatment nutritional status on the treatment outcome of non-Hodgkin lymphoma has never been explored. Among the 953 patients who were registered in a prospective cohort at Samsung Medical Center., we analyzed 262 patients who had been treated with Ruximab-cyclophosphamide, doxorubicin, vincristine, and prednisone for newly diagnosed diffuse large B-cell lymphoma (DLBCL) and for whom data were available regarding pretreatment nutritional status. Nutritional status at diagnosis was assessed by triceps skin fold (TSF), mid-arm muscle circumference (MAMC), body mass index (BMI), serum albumin, prealbumin, and transferrin. For patients aged 60 yr and older, poor performance and higher tumor burden were associated with malnourishment represented by albumin <3.5 g/dL, prealbumin < 17 g/dL, and transferrin <170 mg/L. Lower BMI (<20), serum albumin, prealbumin, and transferrin were identified as risk factors for febrile neutropenia in univariate analysis, but not in multivariate analysis. In the univariate analysis for OS, all nutritional parameters except MAMC showed a significant association with survival. However, BMI was the only parameter that was independently prognostic for OS in the multivariate analysis (P = 0.031; hazards ratio = 3.32). Nutritional insufficiency encountered in DLBCL patients might influence the occurrence of treatment-related toxicity and poor survival outcome of patients.

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

“…Several studies demonstrated that a higher BMI is associated with a higher prevalence [30,31] and with favorable outcomes in DLBCL patients [11], while another study found no prognostic effect [14] (Table 7). In the present study, we showed that an extremely low BMI (<18.5 kg/m 2 ) had a negative prognostic impact, with results similar to those reported by Park et al [12]. However, contrary to the results reported by Carson et al [11] showing a linear, proportional relationship between BMI and estimated survival rate, we observed a non-linear trend between BMI and the estimated 3-year survival.…”

“…Most authors have used values based on the WHO international classification of obesity [3] to discriminate BMI groups [10,11,14]. By contrast, Park et al [12] and Weiss et al [13] used a dichotomized classification with a cutoff of 20.0 and 25.0 kg/m 2 , respectively. In the present study, the use of the WHO classification modified for Korean patients and split into five tiers maximally flattened the smoothing curve of Martingale residuals compared with the two-tiered classification, suggesting that the optimized model had better predictability [28].…”

“…By contrast, many recent studies demonstrated that being in the high BMI group is associated with a favorable outcome in diffuse large B cell lymphoma (DLBCL) patients [10][11][12][13]. However, as BMI classification criteria were not unified among the previous studies and have not taken into account patient ethnicity, the prognostic utility of BMI is still under debate [14].…”

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

“…We performed ROC curve analysis to determine the optimal BMI cutoff with which to distinguish between the two groups and found that the cutoff was 19.95. Because a BMI = 25 was used as the cutoff value in several previous studies, and a BMI = 20 was used as the cutoff value in another study [7, 9, 10, 22], we evaluated the prognostic value of each of these BMI cutoff points, as well as the prognostic value of our median BMI (21.2). A BMI ≥ 20 was found to be the threshold value with the smallest P value (P = 0.001 for BMI ≥ 20, P = 0.005 for BMI ≥ 21.2, P = 0.019 for BMI ≥ 25) and was thus considered the most discriminatory threshold value.…”

“…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. In the present study, based on the WHO classification, the total cohort was split into four groups of patients with different OS rates.…”