Hu Min, Ding Yiduo, Zhang Haizhou, Guo Wei, Li Yun, Jin Zhengming, Qu Changju, Xia Fan
Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Pharmacol. 2023 Aug 23;14:1195907. doi: 10.3389/fphar.2023.1195907. eCollection 2023.
The role of body mass index (BMI) in the treatment outcomes of lymphoma patients is controversial. While investigating the efficacy of ABVD-like regimen in Hodgkin lymphoma (HL) patients, we observed that obese patients had poor responses. To better understand this clinical phenomenon, we evaluated the effect of BMI on responses to ABVD-like chemotherapy in HL patients. This retrospective cohort study evaluated the clinical outcomes of all 67 patients with confirmed HL who were treated at the First Affiliated Hospital of Soochow University from November 2016 to March 2023 with an ABVD-like regimen as first-line chemotherapy. Baseline patient characteristics and clinical outcomes were compared across different BMI categories. The primary end-point was the overall response rate defined as the proportion of the HL patients who achieved complete response or partial response. The additional end-points included progression-free survival and overall survival. The median age of the HL patients was 31 years old. Of the patients, 10.4% were obese, and 17.9% patients were overweight. Interim and end-term response evaluations revealed overall response rates of 98.5% and 83.6%, respectively. The proportion of patients with potential poor prognostic factors (IPS risk factors) did not differ significantly in the responders versus non-responders. However, non-responders had a higher average BMI when compared with responders ( = 0.002). Poor overall response rates in higher BMI patients indeed manifested with shorter progression free survival ( = 0.013). The minimum relative dose of the ABVD-like regimen in the overweight and obese groups was significantly lower than in the normal weight group ( < 0.001). Our analyses show that >80% of newly-diagnosed HL patients responded to the ABVD-like regimen. We find that being obese or overweight at the time of diagnosis correlated with a poorer overall response rate and that BMI was an independent risk factor in HL patients treated with the ABVD-like regimen. Lower doses of ABVD-like regimen contributed to the discrepant findings of responses in the high BMI groups. These findings indicate that newly-diagnosed, obese HL patients receiving an ABVD-like regimen require personalized treatment.
体重指数（BMI）在淋巴瘤患者治疗结果中的作用存在争议。在研究类似ABVD方案对霍奇金淋巴瘤（HL）患者的疗效时，我们观察到肥胖患者反应较差。为了更好地理解这一临床现象，我们评估了BMI对HL患者类似ABVD化疗反应的影响。这项回顾性队列研究评估了2016年11月至2023年3月在苏州大学附属第一医院接受类似ABVD方案作为一线化疗的所有67例确诊HL患者的临床结局。比较了不同BMI类别患者的基线特征和临床结局。主要终点是总缓解率，定义为达到完全缓解或部分缓解的HL患者比例。额外的终点包括无进展生存期和总生存期。HL患者的中位年龄为31岁。其中，10.4%为肥胖患者，17.9%为超重患者。中期和末期缓解评估显示总缓解率分别为98.5%和83.6%。有潜在不良预后因素（国际预后评分系统风险因素）的患者在缓解者与未缓解者中的比例无显著差异。然而，与缓解者相比，未缓解者的平均BMI更高（P = 0.002）。BMI较高患者的总缓解率较差确实表现为无进展生存期较短（P = 0.013）。超重和肥胖组中类似ABVD方案的最小相对剂量显著低于正常体重组（P < 0.001）。我们的分析表明，超过80%的新诊断HL患者对类似ABVD方案有反应。我们发现诊断时肥胖或超重与较差的总缓解率相关，并且BMI是接受类似ABVD方案治疗的HL患者的独立危险因素。较低剂量的类似ABVD方案导致高BMI组反应结果的差异。这些发现表明，新诊断的肥胖HL患者接受类似ABVD方案治疗需要个性化治疗。
