Association of dynamic changes in metabolic syndrome components with clinical outcomes in diffuse large B-cell lymphoma

Abstract

Introduction: Diffuse Large B-Cell Lymphoma (DLBCL) is the most common subtype of Non-Hodgkin Lymphoma (NHL), with 20-40% of patients experiencing poor outcomes despite advancements in treatment. While Metabolic Syndrome (MetS) has been linked to NHL prognosis, its impact on DLBCL outcomes remains unclear.

Methods: This study examined the effects of dynamic changes in MetS components on DLBCL treatment outcomes and prognosis. We retrospectively analyzed 125 newly diagnosed DLBCL patients treated with 6-8 cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) or CHOP-like regimens, with or without rituximab, from May 2010 to May 2022. Group-based trajectory models were used to identify MetS component trajectories. Multivariate logistic regression and Cox proportional hazards regression were employed to determine factors affecting complete remission (CR), progression-free survival (PFS), and overall survival (OS).

Results: The 2-year PFS and OS rates were 70.0% and 82.0%, respectively. High baseline high-density lipoprotein cholesterol (HDL-C) was associated with reduced progression risk (HR = 0.27, 95% CI: 0.10-0.78), while high baseline low-density lipoprotein cholesterol (LDL-C) was linked to decreased CR rate (OR = 0.65, 95% CI: 0.44-0.97) and increased progression risk (HR = 1.78, 95% CI: 1.14-2.79). Additionally, high LDL-C trajectory was associated with reduced CR rates, whereas moderate BMI trajectory was associated with improved CR, PFS, and OS.

Discussion: Therefore, controlling LDL-C levels and maintaining a moderate BMI are crucial for improving DLBCL clinical outcomes.

Keywords: HDL cholesterol; LDL cholesterol; body mass index; diffuse large B-cell lymphoma; metabolic syndrome.

Figure 1

Trajectories of MetS Components. Low, medium, and high trajectory groups for each MetS Components are shown across treatment periods. (A) Body mass index (BMI): Low (20–22 kg/m²), medium (25–26 kg/m²; overweight range), and high (31–32 kg/m²; obesity range); (B) High-density lipoprotein cholesterol (HDL-C) (log-transformed as ln [HDL-C × 100]): Low (0.8–0.9 mmol/L), medium (1.2–1.3 mmol/L), and high (2.4–3.1 mmol/L); (C) Low-density lipoprotein cholesterol (LDL-C) (ln [LDL-C × 100]): Low (1.7–2.2 mmol/L), medium (2.9–3.0 mmol/L), and high (5.3–6.0 mmol/L); (D) Triglycerides (TG) (ln [TG × 100]): Low (0.9–1.0 mmol/L), medium (1.6–2.0 mmol/L), and high (6.0–7.3 mmol/L); (E) Fasting plasma glucose (FPG): Low (5.0–5.4 mmol/L), medium (6.2–7.3 mmol/L), and high (9.0–10.0 mmol/L); (F) Systolic blood pressure (SBP): Low (113–114 mmHg), medium (124–131 mmHg), and high (137–142 mmHg); (G) Diastolic blood pressure (DBP): Low (70–72 mmHg), medium (77–78 mmHg), and high (86–88 mmHg).

Figure 2

Impact of Metabolic Syndrome Component Trajectories on Progression-Free Survival (PFS) in DLBCL Patients. The association of (A) BMI (Body Mass Index), (B) HDL-C (High-Density Lipoprotein Cholesterol), (C) LDL-C (Low-Density Lipoprotein Cholesterol), (D) TG (Triglycerides), (E) SBP (Systolic Blood Pressure), (F) DBP (Diastolic Blood Pressure), and (G) FPG (Fasting Plasma Glucose) trajectories with PFS. BMI and HDL-C trajectories are associated with PFS, with medium-level trajectories showing improved outcomes.

Figure 3

Impact of Metabolic Syndrome Component Trajectories on Overall Survival (OS) in DLBCL Patients. The association of (A) BMI (Body Mass Index), (B) HDL-C (High-Density Lipoprotein Cholesterol), (C) LDL-C (Low-Density Lipoprotein Cholesterol), (D) TG (Triglycerides), (E) SBP (Systolic Blood Pressure), (F) DBP (Diastolic Blood Pressure), and (G) FPG (Fasting Plasma Glucose) trajectories with OS. The medium BMI and HDL-C trajectory group shows a significant reduction in mortality risk compared to the low group.