Original Article

The Obesity Controversy: Does It Impact Treatment Response in Diffuse Large B-Cell Lymphoma?


Background: We aimed to investigate the association of body mass index (BMI) with treatment response in patients with DLBCL

Material and Methods: Seventy-nine DLBCL subjects were included in this study. Data about patient age, sex, serum LDH level, presence of B symptoms, IPI score, ECOG performance score, disease stage, extranodal involvement, and BMI values at diagnosis were retrieved by retrospective patient record review. Patients were staged according to Ann Arbor classification using CT and/or PET/CT findings, and the presence of B symptoms. Body mass index was calculated by dividing weight in kilograms by height in meters squared (kg/m2). Patients were divided into groups according to their BMI as underweight (BMI≤ 18.5 kg/m2), normal weight (BMI 18.5-25 kg/m2), overweight (BMI 25-30 kg/m2), and obese (BMI≥ 30 kg/m2), as defined by the World Health Organization.

Results: Patients were divided into four groups according to their BMIs, but because there was only one patient in the underweight group, comparisons were performed between normal-weight, overweight, and obese patients. There was no statistically significant difference between these groups in terms of age, sex, serum LDH level, disease stage, presence of B symptoms, extranodal involvement, ECOG performance score, IPI score, and treatment response (p= 0.070, 0.704, 0.325, 0.464, 0.254, 0.152, 0.658, 0.620, and 0.947, respectively)

Conclusion: In our study, we showed that BMI has no significant impact on treatment response in patients with DLBCL.


1. Rodriguez-Abreu D, Bordoni A, Zucca E. Epidemiology of hematological malignancies. Ann Oncol. 2007;18 Suppl 1:i3-i8.
2. Chaganti S, Illidge T, Barrington S, et al. British Committee for Standards in Haematology. Guidelines for the management of diffuse large B-cell lymphoma. Br J Haematol. 2016;174(1):43-56.
3. Armitage JO. How I treat patients with diffuse large B-cell lymphoma. Blood. 2007;110(1):29-36
4. Mohammed R, Milne A, Kayani K, et al. How the discovery of rituximab impacted the treatment of B-cell non-Hodgkin's lymphomas. J Blood Med. 2019;10:71-84.
5. A predictive model for aggressive non-Hodgkin's lymphoma. International Non-Hodgkin's Lymphoma Prognostic Factors Project. N Engl J Med. 1993;329(14):987-94.
6. Lenz G, Wright G, Dave SS, et al.; Lymphoma/Leukemia Molecular Profiling Project. Stromal gene signatures in large-B-cell lymphomas. N Engl J Med. 2008;359(22):2313-23.
7. Savage KJ, Johnson NA, Ben-Neriah S, et al. MYC gene rearrangements are associated with a poor prognosis in diffuse large B-cell lymphoma patients treated with R-CHOP chemotherapy. Blood. 2009;114(17):3533-7.
8. Aukema SM, Kreuz M, Kohler CW, et al.; Molecular Mechanisms in Malignant Lymphomas Network Project. Biological characterization of adult MYC-translocation-positive mature B-cell lymphomas other than molecular Burkitt lymphoma. Haematologica. 2014;99(4):726-35.
9. Xu-Monette ZY, Wu L, Visco C, et al. Mutational profile and prognostic significance of TP53 in diffuse large B-cell lymphoma patients treated with R-CHOP: report from an International DLBCL Rituximab-CHOP Consortium Program Study. Blood. 2012;120(19):3986-96.
10. Eren R, Hakan ME, Aslan C, et al. The Impact of Bulky Mass on Treatment Response and Overall Survival in Patients with Diffuse Large B-Cell Lymphoma in Rituximab Era. UHOD. 2018;28:248-253.
11. Tilg H, Moschen AR. Adipocytokines: mediators linking adipose tissue, inflammation and immunity. Nat Rev Immunol. 2006;6(10):772-83.
12. Calle EE, Kaaks R. Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat Rev Cancer. 2004 Aug;4(8):579-91.
13. Renehan AG, Tyson M, Egger M, et al. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008;371(9612):569-78.
14. Castillo JJ, Ingham RR, Reagan JL, et al. Obesity is associated with increased relative risk of diffuse large B-cell lymphoma: a meta-analysis of observational studies. Clin Lymphoma Myeloma Leuk. 2014;14(2):122-30.
15. Larsson SC, Wolk A. Body mass index and risk of non-Hodgkin's and Hodgkin's lymphoma: a meta-analysis of prospective studies. Eur J Cancer. 2011;47(16):2422-30.
16. Geyer SM, Morton LM, Habermann TM, et al. Smoking, alcohol use, obesity, and overall survival from non-Hodgkin lymphoma: a population-based study. Cancer. 2010;116(12):2993-3000.
17. Carson KR, Bartlett NL, McDonald JR, et al. Increased body mass index is associated with improved survival in United States veterans with diffuse large B-cell lymphoma. J Clin Oncol. 2012;30(26):3217-22.
18. Lister TA, Crowther D, Sutcliffe SB, et al. Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin's disease: Cotswolds meeting. J Clin Oncol. 1989;7(11):1630-6.
19. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser. 1995;854:1-452.
20. Cheson BD, Fisher RI, Barrington SF, et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol. 2014;32(27):3059-68.
21. Psaltopoulou T, Sergentanis TN, Ntanasis-Stathopoulos I, et al. Anthropometric characteristics, physical activity and risk of hematological malignancies: A systematic review and meta-analysis of cohort studies. Int J Cancer. 2019;145(2):347-359.
22. Boyle T, Connors JM, Gascoyne RD, et al. Physical activity, obesity and survival in diffuse large B-cell and follicular lymphoma cases. Br J Haematol. 2017;178(3):442-447.
23. Miyahara T, Mochinaga S, Kimura S, et al. Effects of tumor type, degree of obesity, and chemotherapy regimen on chemotherapy dose intensity in obese cancer patients. Cancer Chemother Pharmacol. 2013;71(1):175-82.
24. Hourdequin KC, Schpero WL, McKenna DR, et al. Toxic effect of chemotherapy dosing using actual body weight in obese versus normal-weight patients: a systematic review and meta-analysis. Ann Oncol. 2013;24(12):2952-62.
IssueVol 17, No 2 (2023) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijhoscr.v17i2.12643
Diffuse large B-cell Lymphoma; Obesity; Body mass index

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Atak S, Serin I, Demirel N, Dogan E, Aydın D, Nizam N, Mansuroglu I, Eren R. The Obesity Controversy: Does It Impact Treatment Response in Diffuse Large B-Cell Lymphoma?. Int J Hematol Oncol Stem Cell Res. 2023;17(2):75-80.