ABCL-233: Febrile Neutropenia in Patients with Aggressive Large Cell Lymphoma and Diabetes Mellitus

Context One of the major complications in patients with aggressive lymphoma receiving intensive chemo-immunotherapy is febrile neutropenia (FN). Diabetes mellitus (DM) has deleterious effects on the immune system, resulting in an increased risk for infections, as well as a complicated course of infections. Objectives We aimed to examine whether comorbidity with DM, as well as diabetic control, affects the risk of FN or complicates the course of FN in aggressive lymphoma patients. Design, Setting, and Patients This is a retrospective, single-center study. We included all consecutive patients diagnosed with aggressive large cell lymphoma treated at our institute between 2013 and 2017. Demographics, disease-related outcomes, and laboratory data were extracted from electronic medical records. Categorical variables were compared using the ×2 or the Fisher's exact test, and medians were compared with the Mann–Whitney U test. Results 226 patients with aggressive large cell lymphoma were treated in our medical center. Of these, 49 patients (22%) had type 2 DM. There were 129 hospital admissions due to FN in the entire cohort during lymphoma treatment. Patients with DM had higher mean admission rates due to FN compared to patients without DM (0.88 and 0.51 FN admissions per patient, respectively, P=0.004). The admission rate in patients with DM remained higher after age and gender-matched subgroup analysis (P = 0.005). However, the duration of hospitalizations and number of admissions to the ICU were similar in patients with and without DM. In patients with DM, improved glycemic control during hospitalizations due to FN was associated with shorter hospital stay. However, baseline hemoglobin A1c levels were not associated with increased risk for FN or infectious complications. Use of metformin was associated with an improved overall survival in diabetic patients (overall survival not reached compared to 43 months). Conclusions Patients with aggressive large cell lymphoma and DM had higher rates of hospitalizations due to FN. Furthermore, our data suggest that improved glycemic control during hospitalization is associated with a shorter length of hospitalization for FN. The positive effects of metformin in our study cohort may warrant further investigation.