The dynamic effects of nutritional status on chemotherapy-related toxicity in patients with non-Hodgkin’s lymphoma

• Published in: European journal of clinical nutrition Vol. 79; no. 5; pp. 452 - 459
• Main Authors: Zhou, Qian, Yang, HeXiang, Wang, Xinyue, Wang, LiHong, Yan, XueQian, Zhang, BeiRong, Ma, XueHong, Li, GuoHua, Li, JingLin, Zhang, JiaHui, Yan, ZhiHong, Bao, Ni, Li, Chao, Ge, Peng, Liu, Jia, Luo, Xiaoqin
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.05.2025; Nature Publishing Group
• Subjects: 631/67; 692/700; Adult; Aged; Antineoplastic Agents - adverse effects; Antineoplastic Agents - therapeutic use; Bone marrow; Chemotherapy; Clinical Nutrition; Epidemiology; Female; Humans; Internal Medicine; Lymphoma; Lymphoma, Non-Hodgkin - drug therapy; Lymphoma, Non-Hodgkin - mortality; Male; Malnutrition; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Myelosuppression; Non-Hodgkin's lymphoma; Nutritional Status; Public Health; Survival; Survival analysis; Toxicity; Variance analysis
• ISSN: 0954-3007; 1476-5640; 1476-5640
• DOI: 10.1038/s41430-025-01565-6

Background/Objectives Understanding the dynamic changes in nutritional status of patients with non-Hodgkin’s lymphoma (NHL) during chemotherapy is crucial, as it significantly impacts chemotherapy-related toxicity and survival outcomes. Subjects/Methods This multi-center study included newly diagnosed NHL patients. Nutritional status and chemotherapy-related toxic effects were assessed over the first five chemotherapy sessions, with follow-ups conducted every 3 months. Patients were categorized into three groups based on pre-chemotherapy Patient-Generated Subjective Global Assessment (PG-SGA) scores: Group A (0–1), Group B (2–8), and Group C (>9). Repeated-measures ANOVA and Generalized Estimating Equations (GEE) models were used for analysis, with survival outcomes evaluated via Kaplan–Meier and Cox regression. Results A total of 143 patients (mean age 50.26 ± 15.02 years) completed the study, over a median follow-up of 18.8 months. PG-SGA scores were highest in Group C during chemotherapy ( P  < 0.001), with significant time-group interaction effects ( P  < 0.001). Liver and kidney impairments worsened across all groups ( P  < 0.05), while gastrointestinal toxicity and bone marrow suppression initially decreased before increasing. GEE analysis showed that nutritional status positively influenced gastrointestinal toxicity ( β  = 0.05, P  = 0.001) and bone marrow suppression ( β  = 0.04, P  = 0.014). Malnourished patients exhibited worse pulmonary infection-free survival and overall survival ( P  < 0.05). Conclusions NHL patients are highly susceptible to malnutrition during chemotherapy, which exacerbates chemotherapy-related toxicities, particularly gastrointestinal effects and myelosuppression. Maintaining good initial nutrition is vital for reducing toxicities and improving survival outcomes.