Steroid-Induced Hyperglycemia and Its Effect on Outcomes of R-CHOP Chemotherapy for Non-Hodgkin Lymphoma

Abstract

Large doses of steroids are integral to R-CHOP, a first-line systemic therapy for diffuse large B-cell lymphoma (DLBCL), an aggressive form of non-Hodgkin Lymphoma (NHL). Patients on R-CHOP often develop clinically significant hyperglycemia from steroids. There is evidence of harms from steroid-induced hyperglycemia in the context of chemotherapy which are associated with a reduction in overall survival [1, 2]. The objective of our study was to characterize the effect of steroid-induced hyperglycemia on outcomes of R-CHOP chemotherapy for DLBCL. Methods: We performed a retrospective chart review of 188 patients with DLBCL treated with R-CHOP through CancerCare Manitoba (CCMB) from January 01, 2010 to December 31, 2014. Patients diagnosed with DLBCL were identified through the Manitoba Cancer Registry. The CCMB electronic medical record was reviewed to examine association between steroid-induced hyperglycemia and subsequent infection, including febrile neutropenic events, and overall survival (OS). Results: Patients who developed hyperglycemia with steroid exposure became hyperglycemic during their first R-CHOP cycle. No significant differences in OS or rates of infection were found between the two groups. Conclusions: Patients destined to develop steroid-induced hyperglycemia declare themselves early in the course of steroid exposure. No statistically significant reduction in overall survival attributable to steroid-induced hyperglycemia was found.