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Chronic lymphocytic leukemia

Influence of obesity and gender on treatment outcomes in patients with chronic lymphocytic leukemia (CLL) undergoing rituximab-based chemoimmunotherapy

Leukemia volume 34, pages 1177–1181 (2020)Cite this article

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Obesity has become a major public health issue especially in countries with Western life styles where 25% of the population are obese (i.e., body mass index (BMI) ≥ 30 kg/m²) [1]. While a high BMI is regarded as a risk factor for certain cancers, the impact of obesity on cancer treatment outcomes is—in contrast to the negative impact of underweight and cachexia—controversial and differs between genders, diagnoses, and treatment modalities [2]. Several studies have shown impaired survival in obese patients with breast cancer [3], while in colorectal carcinoma only extreme obesity was associated with adverse outcomes [4]. In melanoma, obesity was associated with prolonged survival in patients who received targeted therapy or immune-checkpoint inhibition in contrast to conventional chemotherapy [5].

Also in hematological malignancies, the prognostic impact of obesity is discordant: a comprehensive analysis identified obesity as a risk factor for survival in elderly female patients with aggressive lymphoma undergoing chemoimmunotherapy [6] and two other studies have demonstrated shorter overall and disease-specific survival in different types of lymphoma [7, 8]. In lymphoma, large retrospective studies have found improved survival for overweighted or obese patients [9,10,11,12].

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Acknowledgements

We wish to thank the patients and their treating physicians who participated in the trials. This work was presented in part at the Annual Meeting of the American Society of Hematology (San Diego, USA, December 1–4, 2018). The CLL4 and CLL10 trials were conducted as investigator-initiated trials by the GCLLSG. They were supported by research grants from MedacSchering Onkologie, Roche Pharma AG, Mundipharma, and a grant from the German Federal Ministry of Education. The CLL8 study was conducted as an investigator-initiated trial by the GCLLSG from 2003 to 2004 and afterward sponsored by F. Hoffmann-La Roche.

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Authors and Affiliations

  1. Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany

    Moritz Fürstenau, Sandra Robrecht, Anna-Maria Fink, Othman Al-Sawaf, Petra Langerbeins, Paula Cramer, Julia Von Tresckow, Christian Maurer, Nadine Kutsch, Kirsten Fischer, Barbara Eichhorst, Michael Hallek & Sebastian Theurich

  2. Department of Internal Medicine I, Bone Marrow Transplantation, Medical University of Vienna, Vienna, Austria

    Georg Hopfinger

  3. Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, München Klinik Schwabing, Munich, Germany

    Manuela Hoechstetter & Clemens-Martin Wendtner

  4. Department of Medicine III, University Hospital, Ludwig-Maximilians-Universität (LMU) München, Munich, Germany

    Martin Dreyling, Michael von Bergwelt-Baildon & Sebastian Theurich

  5. Evangelisches Krankenhaus Hamm, Hamm, Germany

    Elisabeth Lange

  6. Department II of Internal Medicine, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany

    Michael Kneba

  7. Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany

    Stephan Stilgenbauer & Hartmut Döhner

  8. Department of Hematology, Oncology and Rheumatology and José Carreras Center for Immuno and Gene Therapy, Saarland University Medical School, Homburg/Saar, Germany

    Stephan Stilgenbauer

  9. Mannheim Oncology Practice, Mannheim, Germany

    Manfred Hensel

  10. Department of Internal Medicine, Frankfurt (Oder) General Hospital, Frankfurt/Oder, Germany

    Michael G. Kiehl

  11. Department of Medicine I, Clinical Division of Hematology and Hemostaseology and Comprehensive Cancer Center (CCC), Medical University of Vienna, Vienna, Austria

    Ulrich Jaeger

  12. Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital, Cologne, Germany

    Valentin Goede

  13. Gene Center, Cancer- and Immunometabolism Research Group, Ludwig-Maximilians-Universität (LMU) München, Munich, Germany

    Sebastian Theurich

Authors
  1. Moritz Fürstenau
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  2. Georg Hopfinger
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  13. Elisabeth Lange
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  14. Michael Kneba
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  15. Stephan Stilgenbauer
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  17. Manfred Hensel
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  18. Michael G. Kiehl
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  19. Ulrich Jaeger
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  20. Clemens-Martin Wendtner
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  21. Valentin Goede
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  22. Kirsten Fischer
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  23. Michael von Bergwelt-Baildon
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Corresponding authors

Correspondence to Moritz Fürstenau or Sebastian Theurich.

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Conflict of interest

GH reports personal fees from Novartis, personal fees from Celgene, and personal fees from Gildead outside the submitted work. A-MF reports personal fees (advisory board) from Janssen Pharmaceutical during the conduct of the study. OA-S reports Honoraria from Roche, Gilead, AbbVie, and Janssen. PL reports consultancy for Janssen, Sunesis, Mundipharma, and Roche, travel grants from Janssen, Mundipharma, and Roche, and research funding from Janssen, AbbVie, and Roche. PC reports consultancy for AbbVie, Acerta, Janssen, Novartis, and AstraZeneca, honoraria from AbbVie, Roche, and Janssen, research funding from AbbVie, Acerta, Roche, Gilead, GlaxoSmithKline, Janssen, and Novartis, and travel grants from AbbVie, Roche, Gilead, Janssen, and Mundipharma. JvT reports consultancy for Roche, Janssen, AbbVie, and Celgene, honoraria from AbbVie, Roche, and Janssen, travel grants from Roche, Janssen, and Celgene, and research funding from Roche and Janssen. NK reports research funding from Gilead and travel grants from Mundipharma, AbbVie, and Janssen. MH reports consultancy for Gilead and travel grants from Gilead, AbbVie, and Hexal. MD reports personal fees from Acerta, Bayer, Gilead, Novartis, and Sandoz, grants and personal fees from Celgene, Janssen, and Roche, and grants from Mundipharma outside the submitted work. MK reports personal fees from Roche and AbbVie. SS reports grants, personal fees, and nonfinancial support from AbbVie, Amgen, AstraZeneca, Celgene, Gilead, GSK, Hoffmann-La Roche, Janssen, Novartis, Pharmacyclics, and Sunesis outside the submitted work. HD reports personal fees from Agios, AbbVie, Amgen, Astellas, Astex, Celator, Celgene, Janssen, Jazz, Novartis, Seattle Genetics, and Sunesis and research funding from AROG, Bristol Myers Squibb, Celgene, Novartis, Pfizer, and Sunesis. C-MW reports grants and personal fees from Hoffmann-La Roche, and grants and personal fees from Mundipharma during the conduct of the study, grants and personal fees from Hoffmann-La Roche, Mundipharma, Janssen-Cilag, AbbVie, Gilead, Novartis, Celgene, and MorphoSys outside the submitted work. VG reports personal fees from Roche, Janssen, Gilead, and AbbVie outside the submitted work. KF reports personal fees (travel support) from Roche. MH reports research grants from Roche, Gilead, Mundipharma, Janssen, Celgene, Pharmacyclics, and AbbVie, and speakers bureau and advisory board for Roche, Gilead, Mundipharma, Janssen, Celgene, Pharmacyclics, and Boehringer. BE reports research grants from AbbVie, Gilead, Janssen, Roche, and Beigene and personal fees and advisory boards from the same companies and Celgene and Novartis in addition. MF, SR, CM, EL, MH, MGK, MvB, and ST declare that they have no conflict of interest.

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Fürstenau, M., Hopfinger, G., Robrecht, S. et al. Influence of obesity and gender on treatment outcomes in patients with chronic lymphocytic leukemia (CLL) undergoing rituximab-based chemoimmunotherapy. Leukemia 34, 1177–1181 (2020). https://doi.org/10.1038/s41375-019-0630-6

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