Steroid-Induced Hyperglycemia and Its Effect on Outcomes of R-CHOP Chemotherapy for Diffuse Large B-Cell Lymphoma

• Published in: Current oncology (Toronto) Vol. 30; no. 12; pp. 10142 - 10151
• Main Authors: Kristjanson, Mark, Lambert, Pascal, Decker, Kathleen M., Bruin, Sonja, Tingey, Elizabeth, Skrabek, Pamela
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 28.11.2023
• Subjects: Antibodies, Monoclonal, Murine-Derived - adverse effects; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Humans; hyperglycemia; Hyperglycemia - chemically induced; Hyperglycemia - drug therapy; lymphoma; Lymphoma, Large B-Cell, Diffuse - drug therapy; Prednisone - adverse effects; Retrospective Studies; steroid; toxicities; hyperglycemia; toxicities; lymphoma; steroid
• ISSN: 1718-7729; 1198-0052; 1718-7729
• DOI: 10.3390/curroncol30120738

Large doses of steroids are integral to R-CHOP, a first-line systemic therapy for diffuse large B-cell lymphoma (DLBCL), an aggressive form of non-Hodgkin Lymphoma (NHL). Patients on R-CHOP often develop clinically significant hyperglycemia from steroids. There is evidence of harms from steroid-induced hyperglycemia in the context of chemotherapy which are associated with a reduction in overall survival. The objective of our study was to characterize the effect of steroid-induced hyperglycemia on the outcomes of R-CHOP chemotherapy for DLBCL. Methods: We performed a retrospective chart review of 188 patients with DLBCL treated with R-CHOP through CancerCare Manitoba (CCMB) from 1 January 2010 to 31 December 2014. Patients diagnosed with DLBCL were identified using the Manitoba Cancer Registry. The CCMB electronic medical record was reviewed to examine the association between steroid-induced hyperglycemia and subsequent infection, including febrile neutropenic events and overall survival (OS). Results: Patients who developed hyperglycemia with steroid exposure became hyperglycemic during their first R-CHOP cycle. No significant differences in OS or rates of infection were found between euglycemic and hyperglycemic subjects. Conclusions: Patients destined to develop steroid-induced hyperglycemia declare themselves early in the course of steroid exposure. No statistically significant reduction in overall survival attributable to steroid-induced hyperglycemia was found.