Underweight
BMI
Independently Predicts Inferior Survival in
DLBCL
Treated With R‐
CHOP
: A Lympho
Yao Yao, Serif Sungur, Cameron Wellard, Eliza Chung, Susan Morgan, Denise Lee, Geoffrey Chong, Chan Y. Cheah, Eliza A. Hawkes, Erica M. Wood, Nada Hamad, Anna M. Johnston, Tasman Armytage ABSTRACT
Objectives
BMI may capture clinically relevant differences in host reserve and treatment vulnerability in diffuse large B‐cell lymphoma (DLBCL). We evaluated the association between BMI and survival outcomes.
Methods
Adults with DLBCL receiving first‐line R‐CHOP chemoimmunotherapy from 2016 to 2026 were identified from the Lymphoma and Related Diseases Registry. BMI was analysed as underweight, normal weight/overweight, obese Class I and obese Class II/III. Overall survival (OS) and progression‐free survival (PFS) were analysed using Kaplan–Meier and Cox models adjusted for International Prognostic Index (IPI) components, sex and cardiac history.
Results
Among 1600 patients, 43 (2.7%) were underweight, 303 (18.9%) had obese Class I BMI and 198 (12.4%) had obese Class II/III BMI. At median follow‐up of 35.4 months, 342 deaths occurred, including 15 in underweight patients. OS differed by BMI category (log‐rank p = 0.017), whereas PFS did not (log‐rank p = 0.082). In complete‐case multivariable analysis, underweight BMI remained associated with inferior OS (adjusted HR, 1.89; 95% CI, 1.06–3.37). Exploratory analyses did not identify chemotherapy exposure, including upfront dose reduction, or measured malnutrition/systemic illness markers that explained this association.
Conclusions
Underweight BMI identified patients at increased risk of inferior survival, even after adjustment for IPI‐based prognostic factors. Obese BMI categories were not associated with inferior survival.