No data are available regarding obesity and outcome in Chronic Lymphocytic Leukemia (CLL). We analyzed 263 patients from the AGMT CLL-8a Mabtenance trial for the impact of obesity. The trial included patients after rituximab-containing induction treatment in first or second line that had achieved at least a PR. A randomization to rituximab maintenance treatment (375 mg/m2 q3 months for 2 years) vs observation was performed. In this cohort 22% of the patients (58/263) were classified as obese. The baseline response to induction treatment was inferior in obese patients with a lower CR rate (43.1% vs 60.5% in obese vs non-obese, P = 0.018) and with a lower rate of patients achieving MRD negativity after chemoimmunotherapy induction treatment (19.6% vs 35.8%, P = 0.02). The PFS outcome of obese patients was significantly worse in the observation group of the trial (24 vs 39 months median PFS, P = 0.03). However, in the rituximab maintenance group the outcome for obese vs non-obese was not different (P = 0.4). In summary, obesity was overall associated with a worse outcome of chemoimmunotherapy induction. However, rituximab maintenance treatment seems to be able to overcome this negative effect.

1st Faculty of Medicine Charles University Prague and General University Hospital Prague Prague Czech Republic

3rd Medical Department for Hematology and Oncology Hanusch Krankenhaus der Wiener Gebietskrankenkasse Vienna Austria

3rd Medical Department Paracelsus Medical University Salzburg Salzburg Austria

4th Department of Internal Medicine Hematology Faculty of Medicine in Hradec Králové University Hospital and Charles University Prague Hradec Králové Czech Republic

Assign Data Management and Biostatistics GmbH Innsbruck Austria

Cancer Cluster Salzburg Salzburg Austria

Clinic of Haematology Regional Institute of Oncology Iasi Iasi Romania

Clinic of Hematology and Transfusiology Slovak Medical University University Hospital Bratislava Bratislava Slovakia

Clinic of Hematology UMHAT St George and Medical University Plovdiv Plovdiv Bulgaria

Clinic of Hematology University Hospital St Marina Varna Varna Bulgaria

Clinic of Medical Hematology Military Medical Academy Sofia Sofia Bulgaria

Department of Clinical Hematology FNsP J A Reimana Prešov Prešov Slovakia

Department of Clinical Oncology 1 National Cancer Institute Bratislava Bratislava Slovakia

Department of Hemato oncology 2 National Cancer Institute Bratislava Bratislava Slovakia

Department of Hemato oncology University Hospital Olomouc Olomouc Czech Republic

Department of Hematology and Transfusion University Hospital Martin Martin Slovakia

Department of Hematology FNsP F D Roosevelta Banská Bystrica Banska Bystrica Slovakia

Department of Internal Medicine 2 University Hospital Krems Karl Landsteiner Private University of Health Sciences Krems Austria

Department of Internal Medicine 3 Kepler Universitätsklinikum GmbH Med Campus 3 Linz Austria

Department of Internal Medicine 4 Klinikum Wels Grieskirchen GmbH Wels Austria

Department of Internal Medicine 5 Medical University Innsbruck Innsbruck Austria

Department of Internal Medicine Hematology University Hospital Kralovske Vinohrady Prague Czech Republic

Department of Medicine 1 Division of Hematology and Hemostaeology Medical University Vienna Vienna Austria

Faculty of Medicine and CEITEC University Hospital Brno Brno Czech Republic

Hematological Clinic NSHATHD Sofia Queen Joanna University Hospital Sofia Bulgaria

Innere Medizin 1 Ordensklinikum Linz GmbH Linz Austria

Innere Medizin 2 Bezirkskrankenhaus Kufstein Kufstein Austria

Innere Medizin Landeskrankenhaus Hall Hall in Tirol Austria

Internal Medicine 2 Hospital of Steyr Steyr Austria

Interne Abteilung Ordensklinikum Linz GmbH Elisabethinen Linz Austria

Salzburg Cancer Research Institute Salzburg Austria

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Wolin KY, Carson K, Colditz GA. Obesity and cancer. Oncologist. 2010;15(6):556‐565. PubMed PMC

Jager U, Fridrik M, Zeitlinger M, et al. Rituximab serum concentrations during immuno‐chemotherapy of follicular lymphoma correlate with patient gender, bone marrow infiltration and clinical response. Haematologica. 2012;97(9):1431‐1438. PubMed PMC

Muller C, Murawski N, Wiesen M, et al. The role of sex and weight on rituximab clearance and serum elimination half‐life in elderly patients with DLBCL. Blood. 2012;119(14):3276‐3284. PubMed

Greil R, Obrtlíková P, Smolej L, et al. Rituximab maintenance versus observation alone in patients with chronic lymphocytic leukaemia who respond to first‐line or second‐line rituximab‐containing chemoimmunotherapy: final results of the AGMT CLL‐8a Mabtenance randomised trial. Lancet Haematol. 2016;3(7):e317‐e329. PubMed

Pfreundschuh M, Muller C, Zeynalova S, et al. Suboptimal dosing of rituximab in male and female patients with DLBCL. Blood. 2014;123(5):640‐646. PubMed

Jaeger U, Trneny M, Melzer H, et al. Rituximab maintenance for patients with aggressive B‐cell lymphoma in first remission: results of the randomized NHL13 trial. Haematologica. 2015;100(7):955‐963. PubMed PMC

Bottcher S, Ritgen M, Fischer K, et al. Minimal residual disease quantification is an independent predictor of progression‐free and overall survival in chronic lymphocytic leukemia: a multivariate analysis from the randomized GCLLSG CLL8 trial. J Clin Oncol. 2012;30(9):980‐988. PubMed

Vimaleswaran KS, Berry DJ, Lu C, et al. Causal relationship between obesity and vitamin D status: bi‐directional Mendelian randomization analysis of multiple cohorts. PLoS Med.. 2013;10(2):e1001383. PubMed PMC