Influence of Hyperglycemia on the Prognosis of Patients with Diffuse Large B-Cell Lymphoma

Abstract

Purpose To explore the effects of primary and secondary hyperglycemia and the application of the hypoglycemic drug metformin on the prognosis of patients with diffuse large B-cell lymphoma (DLBCL). Methods We performed a retrospective analysis of 1767 DLBCL patients.Cox regression method was used for analysis to evaluate the prognostic factors, and the Kaplan-Meier method was used to draw a survival curve to analyze the effect of hyperglycemia and the hypoglycemic drug metformin on the progression-free survival (PFS) and overall survival (OS) of DLBCL patients. Results Our study showed that patients with hyperglycemia tend to have higher age (age>60 years), high body mass index (BMI)(≥24kg/m 2 ), late Ann Arbor stage (III–IV), high international prognostic index (IPI) (3–5 score), high lactic dehydrogenase (LDH) level (>250U/L), bulky disease and comorbidity. Hyperglycemia affects the survival time of the DLBCL population (PFS: adjusted HR 1.41, 95% CI: 1.16–1.70, P <0.001, OS: adjusted HR 1.33, 95% CI:1.09–1.61, P=0.004).Compared with the non-hyperglycemia group, the secondary hyperglycemia increase affects the prognosis of the DLBCL population (P<0.001). Compared with the secondary hyperglycemia group, the primary hyperglycemia group has a poor prognosis (P<0.05). For patients with DLBCL and hyperglycemia (732 patients in total), the use of metformin can improve their PFS and OS (PFS: adjusted HR 0.69, 95% CI: 0.49–0.96, P=0.028, OS: adjusted HR 0.68, 95% CI: 0.49–0.95, P=0.024). Conclusion Hyperglycemia and secondary hyperglycemia are related to the poor prognosis of DLBCL population.For patients with DLBCL combined with hyperglycemia, the application of metformin can improve survival rate.

Steroid-Induced Hyperglycemia and Its Effect on Outcomes of R-CHOP Chemotherapy for Diffuse Large B-Cell Lymphoma

“…Another study by Zhou et al, likewise shows a reduction in PFS and OS in subjects who develop steroid-induced hyperglycemia in the context of therapy with R-CHOP for DLBCL. Of note, the study by Zhou et al, also suggests that the adverse effects of steroid-induced hyperglycemia on PFS and OS can be mitigated with the use of metformin [5]. The objective of our study was to characterize the effect of steroid-induced hyperglycemia on outcomes of R-CHOP chemotherapy for individuals diagnosed with diffuse large B-cell lymphoma (DLBCL) in Manitoba, Canada.…”

“…The high doses of steroids used in chemotherapy regimens for the treatment of leukemias, lymphomas, and multiple myeloma can prove especially problematic in this regard. Steroidinduced hyperglycemia has been associated with an increase in treatment-related toxicities including neutropenia, infection/sepsis [2,4,5], and chemotherapy-related neuropathies [6]. Associations have also been documented between steroid-induced hyperglycemia and a greater risk of failing to complete the intended course of chemotherapy, early disease relapse, and decreased overall survival [2][3][4].…”

Association Between Polymorphism in Diabetes Susceptibility Gene Insulin-Like Growth Factor 2mRNA–Binding Protein 2 and Risk of Diffuse Large B-Cell Lymphoma

“…Current studies have shown that diabetes is an important risk factor for DLBCL, significantly shortening survival time and increasing the risk of death. 4 - 6 Insulin-like growth factor 2mRNA–binding protein 2 (IGF2BP2), which is located on chromosome 3 (3q27.2), is also associated with a higher risk of death. In combination with insulin-like growth factor 2mRNA, it can affect cell differentiation, proliferation, and epigenetic inheritance in various ways, playing a significant role in the development and occurrence of cancer.…”