title: High Body Mass Index in Elderly Patients With DLBCL Treated With Rituximab-Containing Therapy Compensates for Negative Impact of Male Sex.
abstract: The impact of patient body habitus and sex on outcomes in diffuse large B-cell lymphoma (DLBCL) remains controversial. We investigated the impact of body mass index (BMI), body surface area (BSA), age, and sex on clinical outcomes in patients with DLBCL treated in the rituximab era.
  
  
  
  Patients with de novo DLBCL (n=1,386) diagnosed between June 2000 and December 2010 treated with rituximab-containing chemotherapy were identified from the NCCN Oncology Outcomes Database for Non-Hodgkin's Lymphoma. Progression-free survival (PFS) and overall survival (OS) at 3 years were analyzed based on sex, age, and baseline BMI/BSA.
  
  
  
  High BMI was associated with a lower risk of disease progression or death than low or normal BMI, whereas male sex was associated with poor clinical outcomes, especially among elderly patients (age >60 years). Compared with elderly women, elderly men experienced worse PFS (3-year hazard ratio [HR], 1.5) and OS (3-year HR, 1.6), but these differences diminished with increases in BMI and BSA. In multivariable analysis, normal BMI compared with high BMI was independently associated with poor outcomes (3-year PFS HR, 1.5; OS HR, 1.6) after adjusting for sex. Notably, only 13% of elderly men had BMI less than 25 kg/m2and only 26% had BSA less than 2 m2CONCLUSIONS: Analysis of unselected patients with DLBCL treated with rituximab-containing chemotherapy confirmed an age-dependent disadvantage to male sex in treatment outcomes, but this effect is abrogated by higher levels of BMI and BSA in most North American men.
authors.affiliation: From Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Biostatistics and Data Coordinating Center, City of Hope National Medical Center, Duarte, California; Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas; Hematology and Stem Cell Transplantation, City of Hope National Medical Center, Duarte, California; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; Departments of Medicine and Immunology, Roswell Park Cancer Institute, Buffalo, New York; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Medicine/Lymphoma, Memorial Sloan Kettering Cancer Center, New York, New York; and James P. Wilmot Cancer Center, University of Rochester, Rochester, New York.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Zhou
authors.affiliation: From Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Biostatistics and Data Coordinating Center, City of Hope National Medical Center, Duarte, California; Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas; Hematology and Stem Cell Transplantation, City of Hope National Medical Center, Duarte, California; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; Departments of Medicine and Immunology, Roswell Park Cancer Institute, Buffalo, New York; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Medicine/Lymphoma, Memorial Sloan Kettering Cancer Center, New York, New York; and James P. Wilmot Cancer Center, University of Rochester, Rochester, New York.
authors.forename: Alfred W
authors.initials: AW
authors.lastname: Rademaker
authors.affiliation: From Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Biostatistics and Data Coordinating Center, City of Hope National Medical Center, Duarte, California; Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas; Hematology and Stem Cell Transplantation, City of Hope National Medical Center, Duarte, California; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; Departments of Medicine and Immunology, Roswell Park Cancer Institute, Buffalo, New York; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Medicine/Lymphoma, Memorial Sloan Kettering Cancer Center, New York, New York; and James P. Wilmot Cancer Center, University of Rochester, Rochester, New York.
authors.forename: Leo I
authors.initials: LI
authors.lastname: Gordon
authors.affiliation: From Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Biostatistics and Data Coordinating Center, City of Hope National Medical Center, Duarte, California; Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas; Hematology and Stem Cell Transplantation, City of Hope National Medical Center, Duarte, California; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; Departments of Medicine and Immunology, Roswell Park Cancer Institute, Buffalo, New York; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Medicine/Lymphoma, Memorial Sloan Kettering Cancer Center, New York, New York; and James P. Wilmot Cancer Center, University of Rochester, Rochester, New York.
authors.forename: Ann S
authors.initials: AS
authors.lastname: LaCasce
authors.affiliation: From Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Biostatistics and Data Coordinating Center, City of Hope National Medical Center, Duarte, California; Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas; Hematology and Stem Cell Transplantation, City of Hope National Medical Center, Duarte, California; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; Departments of Medicine and Immunology, Roswell Park Cancer Institute, Buffalo, New York; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Medicine/Lymphoma, Memorial Sloan Kettering Cancer Center, New York, New York; and James P. Wilmot Cancer Center, University of Rochester, Rochester, New York.
authors.forename: Allison
authors.initials: A
authors.lastname: Crosby-Thompson
authors.affiliation: From Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Biostatistics and Data Coordinating Center, City of Hope National Medical Center, Duarte, California; Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas; Hematology and Stem Cell Transplantation, City of Hope National Medical Center, Duarte, California; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; Departments of Medicine and Immunology, Roswell Park Cancer Institute, Buffalo, New York; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Medicine/Lymphoma, Memorial Sloan Kettering Cancer Center, New York, New York; and James P. Wilmot Cancer Center, University of Rochester, Rochester, New York.
authors.forename: Ann
authors.initials: A
authors.lastname: Vanderplas
authors.affiliation: From Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Biostatistics and Data Coordinating Center, City of Hope National Medical Center, Duarte, California; Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas; Hematology and Stem Cell Transplantation, City of Hope National Medical Center, Duarte, California; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; Departments of Medicine and Immunology, Roswell Park Cancer Institute, Buffalo, New York; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Medicine/Lymphoma, Memorial Sloan Kettering Cancer Center, New York, New York; and James P. Wilmot Cancer Center, University of Rochester, Rochester, New York.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Abel
authors.affiliation: From Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Biostatistics and Data Coordinating Center, City of Hope National Medical Center, Duarte, California; Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas; Hematology and Stem Cell Transplantation, City of Hope National Medical Center, Duarte, California; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; Departments of Medicine and Immunology, Roswell Park Cancer Institute, Buffalo, New York; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Medicine/Lymphoma, Memorial Sloan Kettering Cancer Center, New York, New York; and James P. Wilmot Cancer Center, University of Rochester, Rochester, New York.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Rodriguez
authors.affiliation: From Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Biostatistics and Data Coordinating Center, City of Hope National Medical Center, Duarte, California; Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas; Hematology and Stem Cell Transplantation, City of Hope National Medical Center, Duarte, California; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; Departments of Medicine and Immunology, Roswell Park Cancer Institute, Buffalo, New York; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Medicine/Lymphoma, Memorial Sloan Kettering Cancer Center, New York, New York; and James P. Wilmot Cancer Center, University of Rochester, Rochester, New York.
authors.forename: Auayporn
authors.initials: A
authors.lastname: Nademanee
authors.affiliation: From Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Biostatistics and Data Coordinating Center, City of Hope National Medical Center, Duarte, California; Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas; Hematology and Stem Cell Transplantation, City of Hope National Medical Center, Duarte, California; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; Departments of Medicine and Immunology, Roswell Park Cancer Institute, Buffalo, New York; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Medicine/Lymphoma, Memorial Sloan Kettering Cancer Center, New York, New York; and James P. Wilmot Cancer Center, University of Rochester, Rochester, New York.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Kaminski
authors.affiliation: From Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Biostatistics and Data Coordinating Center, City of Hope National Medical Center, Duarte, California; Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas; Hematology and Stem Cell Transplantation, City of Hope National Medical Center, Duarte, California; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; Departments of Medicine and Immunology, Roswell Park Cancer Institute, Buffalo, New York; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Medicine/Lymphoma, Memorial Sloan Kettering Cancer Center, New York, New York; and James P. Wilmot Cancer Center, University of Rochester, Rochester, New York.
authors.forename: Myron S
authors.initials: MS
authors.lastname: Czuczman
authors.affiliation: From Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Biostatistics and Data Coordinating Center, City of Hope National Medical Center, Duarte, California; Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas; Hematology and Stem Cell Transplantation, City of Hope National Medical Center, Duarte, California; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; Departments of Medicine and Immunology, Roswell Park Cancer Institute, Buffalo, New York; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Medicine/Lymphoma, Memorial Sloan Kettering Cancer Center, New York, New York; and James P. Wilmot Cancer Center, University of Rochester, Rochester, New York.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Millenson
authors.affiliation: From Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Biostatistics and Data Coordinating Center, City of Hope National Medical Center, Duarte, California; Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas; Hematology and Stem Cell Transplantation, City of Hope National Medical Center, Duarte, California; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; Departments of Medicine and Immunology, Roswell Park Cancer Institute, Buffalo, New York; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Medicine/Lymphoma, Memorial Sloan Kettering Cancer Center, New York, New York; and James P. Wilmot Cancer Center, University of Rochester, Rochester, New York.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Zelenetz
authors.affiliation: From Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Biostatistics and Data Coordinating Center, City of Hope National Medical Center, Duarte, California; Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas; Hematology and Stem Cell Transplantation, City of Hope National Medical Center, Duarte, California; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; Departments of Medicine and Immunology, Roswell Park Cancer Institute, Buffalo, New York; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Medicine/Lymphoma, Memorial Sloan Kettering Cancer Center, New York, New York; and James P. Wilmot Cancer Center, University of Rochester, Rochester, New York.
authors.forename: Joyce
authors.initials: J
authors.lastname: Niland
authors.affiliation: From Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Biostatistics and Data Coordinating Center, City of Hope National Medical Center, Duarte, California; Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas; Hematology and Stem Cell Transplantation, City of Hope National Medical Center, Duarte, California; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; Departments of Medicine and Immunology, Roswell Park Cancer Institute, Buffalo, New York; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Medicine/Lymphoma, Memorial Sloan Kettering Cancer Center, New York, New York; and James P. Wilmot Cancer Center, University of Rochester, Rochester, New York.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Friedberg
authors.affiliation: From Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Biostatistics and Data Coordinating Center, City of Hope National Medical Center, Duarte, California; Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas; Hematology and Stem Cell Transplantation, City of Hope National Medical Center, Duarte, California; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; Departments of Medicine and Immunology, Roswell Park Cancer Institute, Buffalo, New York; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Medicine/Lymphoma, Memorial Sloan Kettering Cancer Center, New York, New York; and James P. Wilmot Cancer Center, University of Rochester, Rochester, New York.
authors.forename: Jane N
authors.initials: JN
authors.lastname: Winter
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000069283:Rituximab / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D000069283:Rituximab