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

Beason, Tracey S.; Chang, Su‐Hsin; Sanfilippo, Kristen M.; Luo, Suhong; Colditz, Graham A.; Vij, Ravi; Tomasson, Michael H.; DiPersio, John F.; Stockerl-Goldstein, Keith; Ganti, Arun; Wildes, Tanya M.; Carson, Kenneth R.

doi:10.1634/theoncologist.2013-0015

Cited by 40 publications

(36 citation statements)

References 33 publications

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“…Mean BMI was calculated based upon height and weight measurements before MGUS diagnosis. 26 BMI was categorized as underweight (<18·5 kg/m 2 ), normal-weight (18·5–24·9 kg/m 2 ), overweight (25–29·9 kg/m 2 ), or obese (≥30 kg/m 2 ). Race was categorized as white, black, or other.…”

Section: Methodsmentioning

confidence: 99%

Association between metformin use and progression of monoclonal gammopathy of undetermined significance to multiple myeloma in US veterans with diabetes mellitus: a population-based retrospective cohort study

Chang

Luo

O’Brian

et al. 2015

The Lancet Haematology

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Background Multiple myeloma (MM) is one of the most common hematologic malignancies in the United States and is consistently preceded by monoclonal gammopathy of undetermined significance (MGUS). Methods A retrospective cohort of patients in the U.S. Veterans Health Administration database diagnosed with MGUS between 1, October, 1999 and 31, December, 2009 and diabetes mellitus prior to their MGUS diagnosis was identified and followed through 6, August, 2013. Patient-level clinical data were reviewed to verify diagnoses and to abstract data on size of baseline M-protein and type of MGUS, i.e., immunoglobulin (Ig) subtype or light-chain, when available. Metformin users were defined as patients that were prescribed metformin for at least 4 years, with no single break between consecutive prescriptions ≥6 months. Kaplan-Meier curves and Cox models were used to analyze the association between metformin use and the progression of MGUS to MM. Findings The analytic cohort consisted of 2,003 MGUS patients with a median follow-up time of 69 months. Within the analytic cohort, 463 metformin users (23·1%) were identified. Among the metformin users, 13 patients progressed to MM, while 74 patients progressed to MM among the non-metformin users. Metformin use was associated with a reduced risk of transformation to MM (Hazard ratio, HR: 0·47; 95% confidence interval, CI: 0·25–0·87). Interpretation For diabetics diagnosed with MGUS, metformin use for 4 years or longer was associated with a reduced risk of transformation of MGUS to MM. Prospective studies are required to determine whether this association is causal and whether these results can be extrapolated to non-diabetics.

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Section: Methodsmentioning

confidence: 99%

Association between metformin use and progression of monoclonal gammopathy of undetermined significance to multiple myeloma in US veterans with diabetes mellitus: a population-based retrospective cohort study

Chang

Luo

O’Brian

et al. 2015

The Lancet Haematology

Self Cite

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“…However, the data are inconsistent for breast cancer (11) and pancreatic cancer (12, 13), and no associations have been observed in ovarian cancer (14), colorectal cancer (15), lymphoma (14), pancreatic cancer, or esophageal cancer (16). In contrast, higher BMI at diagnosis has been associated with better prognosis in acute myeloid leukemia (17), multiple myeloma (18), head and neck cancers (19), and among women with non-Hodgkins lymphoma (9). There are scant data on the effects of BMI at diagnosis among other populations of cancer patients, and few analyses have made comparisons across multiple cancer types or across different stages of cancer diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Association between Body Mass Index and Cancer Survival in a Pooled Analysis of 22 Clinical Trials

Greenlee

Unger

LeBlanc

et al. 2017

Cancer Epidemiology, Biomarkers &Amp; Prevention

142

100

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BACKGROUND Data are inconsistent on the association between body mass index (BMI) at time of cancer diagnosis and prognosis. We used data from 22 clinical treatment trials to examine the association between BMI and survival across multiple cancer types and stages. METHODS Trials with ≥5 years of follow-up were selected. Patients with BMI<18.5kg/m2 were excluded. Within a disease, analyses were limited to patients on similar treatment regimens. Variable cutpoint analysis identified a BMI cutpoint that maximized differences in survival. Multivariable Cox regression analyses compared survival between patients with BMI above versus below the cutpoint, adjusting for age, race, sex, and important disease-specific clinical prognostic factors. RESULTS A total of 11,724 patients from 22 trials were identified. Fourteen analyses were performed by disease site and treatment regimen. A cutpoint of BMI=25kg/m2 maximized survival differences. No statistically significant trend across all 14 analyses was observed (mean HR=0.96, P=.06). In no cancer/treatment combination was elevated BMI associated with an increased risk of death; for some cancers there was a survival advantage for higher BMI. In sex-stratified analyses, BMI≥25kg/m2 was associated with better overall survival among men (HR=0.82; P=.003), but not women (HR=1.04; P=.86). The association persisted when sex-specific cancers were excluded, when treatment regimens were restricted to dose based on body-surface area, and when early stage cancers were excluded. CONCLUSION The association between BMI and survival is not consistent across cancer types and stages. IMPACT Our findings suggest that disease, stage, and gender specific body size recommendations for cancer survivors may be warranted.

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“…It is becoming clear, however, that obesity and diabetes can accelerate cancer progression, tumor growth or drug resistance in the marrow. Specifically for multiple myeloma (MM), although individual studies have disagreed [1], the most recent pooled analysis of 20 prospective studies found clear associations between increased risk of death from MM in patients with a higher body mass index (BMI) during early adulthood, as well as higher BMI and higher waist circumferences at study entry [2]. In addition, Bredella et al found that patients who were recently diagnosed with MM had higher abdominal fat cross-sectional areas and higher fat metabolic activity compared to patients with Monoclonal Gammopathy of Undetermined Significance (MGUS) [3].…”

Section: Obesity Adipose Tissue and Cancermentioning

confidence: 99%

Reflections on Cancer in the Bone Marrow: Adverse Roles of Adipocytes

2017

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This review highlights the recent advances in our understanding of adipocyte contributions to carcinogenesis or cancer disease progression for cancers in the bone. Purpose In this review, we aim to describe bone marrow adipose tissue and discuss the soluble adipocyte-derived cytokines (adipokines) or endocrine factors, adipocyte-derived lipids, and the actual or putative juxtacrine signaling between bone marrow adipocytes and tumor cells in the bone marrow. This relationship likely affects tumor cell initiation, proliferation, metastasis, and/or drug resistance. Recent Findings Bone marrow adipose may affect tumor proliferation, drug resistance, or cancer-induced bone disease and hence may be a new target in the fight against cancer. Summary Overall, evidence is mixed regarding the role of bone marrow adipose and adipocytes in cancer progression, and more research in this arena is necessary to determine how these bone marrow microenvironmental cells contribute to malignancies in the marrow to identify novel, potentially targetable pathways.

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

Abstract: Learning Objectives Describe the association between baseline BMI, weight loss, and survival in MM. Explain the importance of BMI and baseline weight loss as part of the standard history obtained in patients with MM.

Cited by 40 publications

References 33 publications

Association between metformin use and progression of monoclonal gammopathy of undetermined significance to multiple myeloma in US veterans with diabetes mellitus: a population-based retrospective cohort study

Association between metformin use and progression of monoclonal gammopathy of undetermined significance to multiple myeloma in US veterans with diabetes mellitus: a population-based retrospective cohort study

Association between Body Mass Index and Cancer Survival in a Pooled Analysis of 22 Clinical Trials

Reflections on Cancer in the Bone Marrow: Adverse Roles of Adipocytes

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