Evaluating the prognostic value of body mass index in diffuse large B-cell lymphoma: a systematic review and meta-analysis.

BACKGROUND

The prognostic significance of body mass index (BMI) in diffuse large B-cell lymphoma (DLBCL) remains uncertain. We conducted a systematic review and meta-analysis to evaluate the associations between BMI and overall survival (OS) and progression-free survival (PFS) in patients with DLBCL.

METHODS

A systematic search of the Cochrane Library, PubMed, and Embase was conducted up to April 14, 2026, with additional reference screening. Random-effects models were used to calculate pooled hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

Of 764 records identified, 23 studies were included. In the main analyses, overweight status, defined according to study-specific thresholds, including Asian-specific cutoffs where applicable, was associated with better OS (HR = 0.82, 95% CI: 0.73-0.92, P = 0.001) and PFS (HR = 0.83, 95% CI: 0.72-0.96, P = 0.011). These associations remained consistent in subgroup analyses restricted to studies using R-CHOP-like regimens, multivariable-adjusted estimates, and normal-weight patients as the reference group. In BMI category-specific analyses, underweight status was associated with inferior OS (HR = 1.85, 95% CI: 1.30-2.64, P = 0.001) and PFS (HR = 1.64, 95% CI: 1.11-2.42, P = 0.013). By contrast, overweight status was associated with better OS (HR = 0.77, 95% CI: 0.70-0.84, P < 0.001) and PFS (HR = 0.80, 95% CI: 0.69-0.93, P = 0.004). Obesity was not significantly associated with either OS (HR = 0.93, 95% CI: 0.75-1.15, P = 0.508) or PFS (HR = 0.95, 95% CI: 0.80-1.13, P = 0.541).

CONCLUSION

Available evidence suggests that overweight status may be associated with better survival outcomes in DLBCL, whereas underweight status may be associated with poorer prognosis. Current evidence remains insufficient to confirm a significant prognostic impact of obesity.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42024607212.