Diabetes, metformin use and risk of non‐Hodgkin's lymphoma in postmenopausal women: A prospective cohort analysis in the Women's Health Initiative

Abstract

Epidemiologic evidence is limited about associations between T2DM, metformin, and the risk of non-Hodgkin's lymphoma (NHL). We aimed to examine associations between T2DM, metformin, and the risk of NHL in the Women's Health Initiative (WHI) Study. Information on T2DM status (diabetes status/types of antidiabetic drug use/diabetes duration) from study enrollment and during follow-up were assessed.Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to evaluate associations of T2DM status with risks of overall NHL and its three major subtypes [diffuse large B-cell lymphoma (DLBCL, n = 476), follicular lymphoma (FL, n = 301) and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL, n = 136)] based on multivariable-adjusted Cox proportional hazards models. During a median follow-up of 18.86 years (range, 0.01-25.13; SD ± 6.55), a total of 1637 women developed NHL among 147 885 postmenopausal women. Women with T2DM and with self-reported oral medication use had 38% and 55% higher risk of DLBCL, respectively [multivariable-adjusted model HR = 1.38, 95% CI (1.06-1.81) and

The association between metformin administration and non-Hodgkin lymphoma; a systematic review and meta-analysis of cohort and case-control studies

“…In Figure 6, the sensitivity analysis revealed that the study by Wang et al (23) in 2023 and the study by Kautzky-Willer et al (26) in 2017 had the most significant impact on the current study's results. Specifically, after removing the study by Wang et al, the final meta-analysis result changed to OR = -0.16 (95% CI: -0.23, -0.09), and with the exclusion of the study by Kautzky-Willer et al, the current study's result shifted to OR = -0.04 (95% CI: -0.22, 0.13).…”

“…In this meta-analysis, six observational studies (five cohort studies and one case-control study) with a total of 2 330 787 participants were examined. The smallest study, Ye et al in 2018 (22), had 5242 participants, while the largest study, Kautzky-Willer et al in 2017 (23), included 1,847,051 participants. Other information on the studies under review is provided in Table 1.…”

Metformin and risk of hematological cancers in patients with diabetes: a systematic review and meta-analysis

“…Finally, 11 studies (18 effect sizes) with a total sample size of 2 318 217 participants and 6280 HCs cases, published between 2010 and 2023, were eligible ( Figure 1 ). 4 , 5 , 8 , 19 , 20 , 29 – 34 Some studies reported multiple effect sizes derived from their stratified analysis based on type of cancer or the gender of participants; we extracted all appropriate effect sizes to perform the meta-analyses. Nine of the articles were retrospective or prospective cohort studies; 5 , 19 , 20 , 29 , 30 , 32 – 34 two were nested case-control studies.…”

“… 4 , 5 , 8 , 19 , 20 , 29 – 34 Some studies reported multiple effect sizes derived from their stratified analysis based on type of cancer or the gender of participants; we extracted all appropriate effect sizes to perform the meta-analyses. Nine of the articles were retrospective or prospective cohort studies; 5 , 19 , 20 , 29 , 30 , 32 – 34 two were nested case-control studies. 8 , 31 All studies were on adults.…”

“… 8 , 31 All studies were on adults. Data for non-Hodgkin's lymphoma (NHL) were reported in three studies, 5 , 8 , 32 for multiple myeloma (MM) in three studies with four effect sizes, 19 , 30 , 31 for diffuse large B cell lymphoma (DLBCL) in two studies, 5 , 8 for follicular lymphoma (FL) in two studies, 5 , 8 for leukemia in two studies, 4 , 20 for lymphoma/leukemia in two studies, 33 , 34 for chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) in one study, 8 for plasma cell neoplasms (PCN) in one study, 8 and for the overall HCs in one study. 29 Moreover, the majority of studies reported data for both men and women combined, while one study reported effect sizes for men and women separately, 19 and one study 5 only included women.…”