Chieh-Lin Jerry Teng1,2,3, Kuang-Hsi Chang4, I-Ju Tsai5, Wen-Li Hwang1, Chung Y Hsu6, Wayne H-H Sheu7. 1. Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, Taiwan. 2. Department of Life Science, Tunghai University, 1727 Taiwan Boulevard Sect. 4, Taichung, Taiwan. 3. School of Medicine, Chung Shan Medical University, 110, Sec. 1, Jianguo N. Rd., Taichung, Taiwan. 4. Graduate Institute of Biomedical Sciences, China Medical University, 91 Hsueh-Shih Road, Taichung, Taiwan. 5. Management Office for Health Data, China Medical University Hospital, 91 Hsueh-Shih Road, Taichung, Taiwan. 6. Graduate Institute of Clinical Medical Science, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402, Taiwan. hsuc@mail.cmuh.org.tw. 7. Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan. whhsheu@vghtc.gov.tw.
Abstract
BACKGROUND AND OBJECTIVES: Although anthracyclines are effective chemotherapeutic agents for treating B-cell lymphoma, adverse effects, such as bone marrow suppression and cardiotoxicity, limit their clinical application. We assessed whether anthracycline treatment also increases the risk for diabetes mellitus in patients with B-cell lymphoma. METHODS: Using data obtained from the Taiwanese National Health Insurance Research Database from 2004 to 2011, we compared overall survival and clinical features for B-cell lymphoma patients administered anthracyclines (n = 3147) and those not administered anthracyclines (n = 837). The impact of anthracycline treatment on diabetes risk was further investigated using a Gray's test and multivariate competing-risk regression models in a dose-dependent manner. RESULTS: Anthracycline administration was associated with a higher incidence of diabetes (HR: 1.75; 95% CI 1.11-2.75; p = 0.0163) after adjustments for age, gender, cumulative dose of prednisolone, and co-morbidities. Cumulative anthracycline doses of 253-400 mg (HR: 2.35; 95% CI 1.41-3.91; p = 0.0010), 401-504 mg (HR: 2.26; 95% CI 1.26-4.05; p = 0.0063), and > 504 mg (HR: 2.29; 95% CI 1.25-4.18; p = 0.0072) increased the incidence density of diabetes in a dose-dependent manner (p = 0.0006). The annual alteration of adapted diabetes complications severity index score was not significantly different between B-cell lymphoma patients with or without anthracycline treatment (p = 0.4924). CONCLUSION: Anthracycline therapy increases diabetes risk in a dose-dependent manner in B-cell lymphoma patients. Intensive blood glucose monitoring and control should be recommended for B-cell lymphoma patients receiving anthracycline treatment.
BACKGROUND AND OBJECTIVES: Although anthracyclines are effective chemotherapeutic agents for treating B-cell lymphoma, adverse effects, such as bone marrow suppression and cardiotoxicity, limit their clinical application. We assessed whether anthracycline treatment also increases the risk for diabetes mellitus in patients with B-cell lymphoma. METHODS: Using data obtained from the Taiwanese National Health Insurance Research Database from 2004 to 2011, we compared overall survival and clinical features for B-cell lymphomapatients administered anthracyclines (n = 3147) and those not administered anthracyclines (n = 837). The impact of anthracycline treatment on diabetes risk was further investigated using a Gray's test and multivariate competing-risk regression models in a dose-dependent manner. RESULTS:Anthracycline administration was associated with a higher incidence of diabetes (HR: 1.75; 95% CI 1.11-2.75; p = 0.0163) after adjustments for age, gender, cumulative dose of prednisolone, and co-morbidities. Cumulative anthracycline doses of 253-400 mg (HR: 2.35; 95% CI 1.41-3.91; p = 0.0010), 401-504 mg (HR: 2.26; 95% CI 1.26-4.05; p = 0.0063), and > 504 mg (HR: 2.29; 95% CI 1.25-4.18; p = 0.0072) increased the incidence density of diabetes in a dose-dependent manner (p = 0.0006). The annual alteration of adapted diabetes complications severity index score was not significantly different between B-cell lymphomapatients with or without anthracycline treatment (p = 0.4924). CONCLUSION:Anthracycline therapy increases diabetes risk in a dose-dependent manner in B-cell lymphomapatients. Intensive blood glucose monitoring and control should be recommended for B-cell lymphomapatients receiving anthracycline treatment.
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