Statin use and survival in 16 098 patients with non‐Hodgkin lymphoma or chronic lymphocytic leukaemia treated in the rituximab era

Abstract

Summary Statin use has been associated with reduced mortality from several cancers but also suggested, in vitro, to diminish the effectiveness of lymphoma treatments including rituximab. The present study aimed to assess the association of statin use with mortality in patients with non‐Hodgkin lymphoma (NHL) and chronic lymphocytic leukaemia (CLL). We identified all incident NHLs and CLLs in Sweden from 2007 to 2013 with subtype information in the Swedish Lymphoma and Cancer Registers. Using Cox regression, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of pre‐ or post‐diagnosis statin use (yes/no, intensity) with lymphoma‐specific, cardiovascular, or all‐cause mortality; and for follicular lymphoma (FL) by initial treatment strategy (active/watch‐and‐wait). Among 16 098 incident NHL/CLL patients, 20% used statins at diagnosis. Pre‐ and post‐diagnosis statin use, and statin intensity were not consistently associated with any mortality outcome in patients with NHL, overall or for any subtype. For actively treated patients with FL, statin use did not appear to increase lymphoma‐specific mortality (vs. non‐users, HR [95% CI]after diagnosis 0·87 [0·45–1·67]). For CLL, statin use was associated with all‐cause and cardiovascular but not consistently with lymphoma‐specific mortality. In conclusion, statin use was not associated with improved lymphoma survival but appears safe to use during lymphoma treatment.

Influence of Statins on the Survival Outcomes of Patients with Diffuse Large B Cell Lymphoma: A Systematic Review and Meta-Analysis

“…In the final step of full-text review, another 20 studies were excluded according to the reasons listed in Figure 1. Finally, eight cohort studies were identified and included in the meta-analysis [13][14][15][16][17][18][19][20].…”

“…Eight cohort studies [13][14][15][16][17][18][19][20] involving 9927 patients with DLBCL contributed to this meta-analysis.…”

“…e studies were performed in Switzerland, Japan, the United States, Singapore, Korea, Canada, and Sweden. Two of them were prospective [14,19], while the others were retrospective. All of the studies included patients with DLBCL.…”

“…An early in vitro study showed that statins-induced cholesterol depletion may cause conformational changes of CD20 to escape detection by rituximab, thereby impairing the antilymphoma efficacy of rituximab in CD20 + B cell lymphomas [12]. Subsequent observational studies regarding the influence of statins on the prognosis of DLBCL patients showed inconsistent results [13][14][15][16][17][18][19][20]. An early study showed that statins may adversely affect the prognosis of patients with nongerminal center DLBCL [17], while a recent study suggested that concomitant use of statins may improve the survival of DLBCL patients who were treated with R-CHOP [20].…”

Disputable questions of statins antitumor effects in hemoblastoses

“…Так, в про веденном в 2021 г. исследовании с участием 16 098 боль ных неходжкинскими лимфомами и ХЛЛ, из которых 20 % принимали статины на момент постановки ди агноза, не показано влияния данных препаратов на смертность, связанную с заболеванием. Однако досто верно установлена ассоциация приема статинов с мень шей летальностью от всех причин и сердечнососудистых осложнений, что свидетельствовало о целесообраз ности приема этих препаратов [16]. Данное обстоя тельство позволяет предположить возможность исполь зования статинов не только у взрослых, но и у детей с гемобластозами, поскольку выявлена ассоциация развития атеросклероза с ОЛЛ [3], ОМЛ [5] и хрони ческим миеломоноцитарным лейкозом [6].…”