Department of Hematology, Toyota Kosei Hospital, Japan.
Intern Med. 2022;61(14):2111-2116. doi: 10.2169/internalmedicine.8838-21. Epub 2022 Jul 15.
Objective Follicular lymphoma (FL) is an indolent B-cell malignancy, usually treated by immunochemotherapy in advanced-stage and high-tumor-burden cases. Although some reports have shown no significant relationship between the pre-treatment body mass index (BMI) and the overall survival (OS) in FL, little is known regarding BMI changes during chemotherapy. We analyzed the impact of a BMI decrease during chemotherapy on the OS in FL patients. Methods We retrospectively analyzed 56 patients with untreated advanced FL who underwent chemotherapy at our institute between July 2009 and December 2020. The BMI change was defined based on the BMI before and at three months after the first chemotherapy session. The cut-off for a BMI decrease was set at 1.42 kg/m according to the receiver operating characteristics curve for the OS. We compared the survival outcome between two BMI groups based on this cut-off. Results A BMI decrease was significantly associated with a worse OS (5-year OS: 86.7% vs. 60.5%, p=0.019), although the pre-treatment BMI showed no significant relationship with the survival. The adverse impact of a BMI decrease remained in a multivariate analysis for the OS (hazard ratio, 3.972; p=0.045). The decreased-BMI group tended to show a higher cumulative incidence of early-onset histological transformation (HT) than the non-decreased-BMI group (20% vs. 0.0%). A BMI decrease during chemotherapy in previously untreated FL patients might reflect the hyperactivation of tumor-induced metabolism related to HT. Conclusion A BMI decrease during chemotherapy might be an independent adverse prognostic factor in FL patients. BMI changes in addition to the condition of FL patients should be monitored during chemotherapy.
目的滤泡性淋巴瘤（FL）是一种惰性 B 细胞恶性肿瘤，通常在晚期和高肿瘤负荷病例中采用免疫化疗治疗。尽管一些报告显示 FL 患者治疗前体重指数（BMI）与总生存期（OS）之间没有显著关系，但关于化疗期间 BMI 变化的信息知之甚少。我们分析了化疗期间 BMI 下降对 FL 患者 OS 的影响。方法我们回顾性分析了 2009 年 7 月至 2020 年 12 月在我院接受化疗的 56 例未经治疗的晚期 FL 患者。BMI 变化基于首次化疗前和化疗后三个月的 BMI 定义。根据 OS 的受试者工作特征曲线，将 BMI 下降的截点设定为 1.42kg/m2。我们根据该截点比较了两个 BMI 组的生存结局。结果 BMI 下降与较差的 OS 显著相关（5 年 OS：86.7% vs. 60.5%，p=0.019），尽管治疗前 BMI 与生存无显著关系。在 OS 的多变量分析中，BMI 下降的不良影响仍然存在（风险比，3.972；p=0.045）。与非 BMI 下降组相比，下降 BMI 组更倾向于表现出更高的早期组织学转化（HT）累积发生率（20% vs. 0.0%）。未经治疗的 FL 患者化疗期间 BMI 下降可能反映了与 HT 相关的肿瘤诱导代谢的过度激活。结论化疗期间 BMI 下降可能是 FL 患者的一个独立不良预后因素。在化疗期间，除了监测 FL 患者的病情外，还应监测 BMI 变化。
