Abstract 2170: Body mass index and non-Hodgkin lymphoma survival in an ethnically diverse population: The Multiethnic Cohort study
Authors: Leo Qi Jie Nicholas , Ollberding Nicholas J. , Wilkens Lynne R. , Kolonel Laurence N. , Henderson Brian E. , Marchand Loic L. , Maskarinec Gertraud 
Published: May 2015

Abstract
Introduction: Obesity increases the risk of death for several malignancies including breast and colon cancer. However, for non-Hodgkin's lymphoma (NHL), the association between pre-diagnostic body mass index (BMI) and survival is unclear. We examined the association between BMI before diagnosis and overall and NHL-specific survival in the Multiethnic Cohort (MEC) study of African Americans, Native Hawaiians, Japanese Americans, Latinos, and Caucasians.
Methods: MEC participants free of NHL at cohort entry and diagnosed with NHL as identified through linkages to SEER cancer registries and the National Death Index during follow-up were included in the current analyses (N=1348). Body mass index (BMI) was based on self-reported weight and height at cohort entry. Cox proportional hazards regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for pre-diagnostic BMI categories in relation to all-cause and NHL-specific mortality while adjusting for known confounders.
Results: The mean time from cohort entry to NHL diagnosis was 7.2±3.9 years (range: 0.0-15.0 years). The mean age at NHL diagnosis was 70.6 (range 45-89) years and the mean BMI at cohort entry was 26.5±4.7 kg/m2. After a mean follow-up of 4.3±3.5 years, 679 deaths including 457 NHL-specific deaths occurred. In multivariable models, obese patients (BMI ≥30.0) had higher all-cause (HR = 1.55, 95%CI = 1.21-2.00) and NHL-specific (HR = 1.84, 95%CI = 1.35-2.52) mortality compared to patients with high-normal BMI (22.5-24.9 kg/m2). For overweight patients (BMI 25.0-29.9), the respective HRs were 1.29 (95%CI = 1.05-1.58) and 1.47 (95%CI = 1.14-1.89). A 35% higher risk of all-cause mortality was also observed in patients with low-normal BMI. When BMI was included in the model as a continuous variable, the risk of NHL-specific mortality increased by 3.3% for every increase in one unit of BMI (HR = 1.03, 95% CI = 1.01-1.06, ptrend = 0.004). Stratification by NHL type suggested a higher NHL-specific mortality risk for chronic lymphocytic leukemia/small lymphocytic lymphoma than for diffuse large B-cell lymphoma and follicular lymphoma. The interaction of BMI with ethnicity (p=0.83) was not significant.
Conclusions: Pre-diagnostic obesity may be related to poorer overall and NHL-specific survival in NHL patients. Therefore, prediagnostic BMI may be a suitable prognostic marker for NHL patients.
Citation Format: Qi Jie Nicholas Leo, Nicholas J. Ollberding, Lynne R. Wilkens, Laurence N. Kolonel, Brian E. Henderson, Loic Le Marchand, Gertraud Maskarinec. Body mass index and non-Hodgkin lymphoma survival in an ethnically diverse population: The Multiethnic Cohort study. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2170. doi:10.1158/1538-7445.AM2014-2170