Impact of Obesity on Patients with Diffuse Large B-Cell Lymphoma Receiving CAR T-Cell Therapy.

Abstract

Obesity has been associated with poorer outcomes in conventional cancer therapies. However, its impact on Chimeric Antigen Receptor (CAR) T-cell therapy for patients with diffuse large B-cell lymphoma (DLBCL) remains unclear. This study aims to evaluate how obesity affects in-hospital outcomes and adverse effects in patients with DLBCL receiving CAR-T therapy. Using the National Readmission Database (NRD), we included adults aged ≥18 with DLBCL who received CAR-T therapy between 2018 and 2020. We compared in-hospital outcomes and adverse effects between patients with and without obesity. Propensity score matching (caliper of 0.2, 1:1 ratio) was performed to ensure similar baseline characteristics between the groups. We adjusted the following confounding variables: age, comorbidities such as cardiovascular diseases including hypertension, coronary artery disease, congestive heart disease, and valvular heart disease, diabetes mellitus, hyperlipidemia, cerebrovascular accident, obstructive sleep apnea, liver disease, pulmonary disease, chronic kidney disease, obesity, anemia, and social factors including smoking, alcohol use, and illicit drug use. Data analysis was conducted using R studio software. A total of 1,874 patients with DLBCL who received CAR-T therapy were included in the study. Of these, 171 had obesity (9.1%, 59.5 ± 12.1 years of age, 41.5% female) and 1,703 did not (90.9%, 61.9 ±12.4 years of age, 35.9% female). After propensity score matching, there were 160 patients with obesity (50.0%, 59.7 ± 12.2 years of age, 41.9% female) and 160 patients without obesity (50.0%, 58.6 ± 13.0 years of age, 41.3% female). Patients with obesity had significantly higher rates of early mortality (10.6% vs. 4.4%, p = 0.03) and non-home discharge (18.8% vs. 8.1%, p = 0.01) compared to those without obesity. There were no significant differences in 30-day readmission (18.1% vs. 21.3%, p = 0.48). In terms of in-hospital complications, the rates of acute kidney injury (20.0% vs. 23.1%, p = 0.50), cardiac complications (4.4% vs. 3.8%, p = 0.78), leukopenia (41.3% vs. 44.4%, p = 0.57), neurotoxicity (10.6% vs. 8.1%, p = 0.44), pulmonary embolism (1.3% vs. 0.0%, p = 0.16), and infection (44.4% vs. 43.8%, p = 0.91) were comparable between the two groups. Patients with DLBCL and concomitant obesity receiving CAR-T therapy experienced higher rates of early mortality and non-home discharge compared to non-obese patients. These findings underscore the need for tailored management strategies to improve outcomes for this patient population.