Increased Body Mass Index Is Associated With Improved Survival in United States Veterans With Diffuse Large B-Cell Lymphoma

Abstract

A B S T R A C T PurposeObesity increases the risk of death from many malignancies, including non-Hodgkin's lymphoma (NHL). In diffuse large B-cell lymphoma (DLBCL), the most common form of NHL, the association between body mass index (BMI) at diagnosis and survival is unclear. Patients and MethodsWe evaluated the association between BMI at diagnosis and overall survival in a retrospective cohort of 2,534 United States veterans diagnosed with DLBCL between October 1, 1998 and December 31, 2008. Cox modeling was used to control for patient-and disease-related prognostic variables. ResultsMean age at diagnosis was 68 years (range, 20 to 100 years); 64% of patients were overweight (BMI, 25 to Ͻ 30) or obese (BMI, Ն 30). Obese patients were significantly younger, had significantly fewer B symptoms, and trended toward lower-stage disease, compared with other BMI groups. Cox analysis showed reduced mortality in overweight and obese patients (overweight: hazard ratio [HR], 0.73; 95% CI, 0.65 to 0.83; obese: HR, 0.68; 95% CI, 0.58 to 0.80), compared with normal-weight patients (BMI, 18.5 to Ͻ 25). Treatment during the rituximab era reduced the risk of death without affecting the association between BMI and survival. Diseaserelated weight loss occurred in 29% of patients with weight data 1 year before diagnosis. Cox analysis based on BMI 1 year before diagnosis continued to demonstrate reduced risk of death in overweight and obese patients. ConclusionBeing overweight or obese at the time of DLBCL diagnosis is associated with improved overall survival. Understanding the mechanisms responsible for this association will require further study.

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

“…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. Furthermore, in contrast to the previous report [11], we demonstrated that a very high BMI (≥30.0 kg/m 2 ) had an unfavorable prognosis, which is in agreement with the findings of a recent multiethnic cohort study [32].…”

“…Therefore, initial presentation with an extremely low or high BMI at diagnosis may be considered as a negative prognostic factor in Asian DLBCL patients. 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].…”

“…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].…”

Rituximab maintenance for patients with aggressive B-cell lymphoma in first remission: results of the randomized NHL13 trial

“…Patients with higher body weight and higher body mass index have been shown to profit from prolonged rituximab treatment. 14,23 Men in the NHL13 had a significantly higher body mass index (median 26 versus 25.4,…”

Influence of Body Mass Index on Survival in Veterans With Multiple Myeloma

“…In acute promyelocytic leukemia, for example, elevated BMI before diagnosis is associated with increased disease incidence, and elevated BMI is associated with an increased risk of relapse after treatment [6 -8]. Elevated BMI is also associated with an increased incidence of diffuse large B-cell lymphoma [9], but patients who are overweight or obese at the time of diagnosis demonstrate improved survival compared with those with a healthy-weight BMI [10].…”