Weight and body composition changes during R-CHOP chemotherapy in patients with non-Hodgkin's lymphoma and their impact on dose intensity and toxicity

Purpose: To estimate weight and body composition changes during R-CHOP combination therapy in patients with non-Hodgkin's lymphoma (NHL) and their impact on dose intensity (DI) and toxicity. Methods: We prospectively evaluated body composition in patients with NHL before starting chemotherapy (visit 1), before the 3rd cycle (visit 2) and before the 6th cycle (visit 3). Body composition was assessed by bioelectrical impedance analysis (BIA) and confirmed by anthropometric measurements. Results: Thirty patients with NHL were studied. There was no weight change from visit 1-2, but weight increased from visit 2-3 (-1.36 +/- 1.89 kg) and from visit 1-3 (-1.93 +/- 3.21 kg). Patients with weight gain had significantly better overall response rate (p=0.013) and 5-year survival rate (p < 0.01). Fat mass increased from visit 1-2 (-1.068 +/- 1.72 kg; p=0.002), from visit 2-3 (-1.32 +/- 1.89 kg; p=0.001) and from visit 1-3 (-2.502 +/- 3.23 kg; p=0.001). There was no statistically significant change in lean body mass (LBM) during chemotherapy. Total body water changed significantly from visit 1-2 (-0.08 +/- 2.551 kg; p=0.097), from visit 2-3 (-1.036 +/- 1.10 kg; p=0.001) and from visit 1-3 (-1.89 +/- 3.2l kg; p=0.004). The average relative DI (ARDI) of the R-CHOP regimen was 90% and the rate of complete remission was 63.3%. Overall hematologic toxicity was evident in 14 (46.7%) patients. There was statistical significance between concentrations of cyclophosphamide and doxorubicin (mg/kg fat and mg/kg LBM) whether overall hematologic toxicity was present or not. Conclusion: Patients in the study gained weight during chemotherapy with unfavorable changes in body composition. Attempt has been made to identify clinical variables to predict patients at risk for hematologic toxicity, but an approach for individualizing drug dosing should be continued.