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Diminishing prognostic role of preexisting diabetes mellitus for patients with diffuse large B-cell lymphoma in the rituximab era

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Abstract

Rituximab reforms the treatment of diffuse large B-cell lymphoma (DLBCL) and the prognostic significance of baseline patient features should be reevaluated. Few population-based studies have investigated the association of diabetes mellitus (DM) and outcomes of lymphoma; however, the results remain inconclusive. From January 1, 2000 to December 31, 2009, a total of 468 consecutive newly diagnosed DLBCL patients receiving first-line chemotherapy with cyclophosphamide, vincristine, doxorubicin, and prednisolone (CHOP) or rituximab plus CHOP (R-CHOP) were enrolled. Pre-existing DM was defined according to medical history, use of antidiabetic medications, or any record of an abnormal hemoglobin A1c test. Progression-free survival (PFS) and overall survival (OS) were estimated and compared using the Kaplan–Meier method with a log-rank test. CHOP was administered in 194 patients, and 274 patients received R-CHOP. DM was identified in 16.2 % (76/468) of patients. Diabetic patients were older and more performance restricted, compared to the non-DM patients in both the CHOP and R-CHOP groups. In the CHOP group, 5-year PFS and OS were inferior in DM patients (PFS, 32.4 vs. 50.0 % (P = 0.039); OS, 38.2 vs. 62.5 % (P = 0.002)). However, outcomes were similar for both DM and non-DM patients in the context of R-CHOP treatment (PFS, 69.0 vs. 57.3 % (P = 0.179); OS, 76.2 vs. 69.8 % (P = 0.586)). The response rate of chemotherapy in DM patients was also improved to a level similar to non-DM patients with rituximab use. In conclusion, the prognostic significance of preexisting DM in DLBCL patients is changing in the rituximab era. The potentially additional benefit of rituximab in DM patients merits further investigation.

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Acknowledgments

This study was supported by grants from Taipei Veterans General Hospital (V100B-033) and Taiwan Clinical Oncology Research Foundation. The results of this study were partially presented as a poster at the 17th Congress of the European Hematology Association in Amsterdam, The Netherlands, in June 2012.

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Authors and Affiliations

  1. Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Hsueh-Ju Lu, Yu-Chung Huang, Chun-Yu Liu, Man-Hsin Hung, Ming-Hung Hu, Chia-Yun Wu, Ying-Chung Hong, Liang-Tsai Hsiao, Jyh-Pyng Gau, Jin-Hwang Liu, Cheng-Hwai Tzeng & Yuan-Bin Yu

  2. Division of General Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Hui-Chi Hsu

  3. Division of Transfusion, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Tzeon-Jye Chiou

  4. Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Hsueh-Ju Lu, Yu-Chung Huang, Chun-Yu Liu, Man-Hsin Hung, Ming-Hung Hu, Chia-Yun Wu, Ying-Chung Hong, Liang-Tsai Hsiao, Jyh-Pyng Gau, Jin-Hwang Liu, Hui-Chi Hsu, Tzeon-Jye Chiou, Cheng-Hwai Tzeng & Yuan-Bin Yu

  5. Institute of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Hui-Chi Hsu & Yuan-Bin Yu

  6. Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Yu-Chung Huang & Chun-Yu Liu

  7. Division of Hematology and Medical Oncology, Department of Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan

    Yu-Chung Huang

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  1. Hsueh-Ju Lu
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Corresponding author

Correspondence to Yuan-Bin Yu.

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H.‐J. Lu and Y.‐C. Huang equally contributed to this work.

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Lu, HJ., Huang, YC., Liu, CY. et al. Diminishing prognostic role of preexisting diabetes mellitus for patients with diffuse large B-cell lymphoma in the rituximab era. Ann Hematol 92, 1495–1501 (2013). https://doi.org/10.1007/s00277-013-1789-y

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