In diffuse large B-cell lymphoma (DLBCL), the age-adjusted International Prognostic Index (aaIPI) score is currently used to predict patient outcomes and to choose the best therapeutic treatment. Body mass index (BMI) and gender are occasionally sited as prognostic factors; however, their value has never been studied in a large series of patients included in prospective clinical trials in the rituximab era. To assess the impact of BMI and gender on OS and PFS independently of the aaIPI score, we pooled 985 patients that were prospectively included in GELA studies and uniformly treated with R-CHOP. Univariate analysis indicated that high aaIPI and male gender were associated with a worse PFS, whereas high (>25) or low (<18.5) BMI scores were not. High aaIPI score was the only factor predictive for OS. In a multivariate analysis, including aaIPI score, gender, BMI, and interaction between BMI and gender, aaIPI remained the strongest predictive factor, and BMI < 18.5 was significantly associated with a worse OS but not PFS. In conclusion, in the rituximab era, the aaIPI score remains the major predictor of outcome in DLBCL patients; however, male gender and low BMI seem to impact outcome. 1. Introduction DLBCL is the most frequent type of NHL. The outcome of DLBCL has been remarkably improved in younger as well as elderly patients by rituximab, a chimeric monoclonal antibody targeting the CD20 antigen. A recent update of randomised trials conducted by the GELA group and others evaluating the efficacy of rituximab in addition to CHOP or intensified CHOP (namely, ACVBP: 75？mg/m2 doxorubicin and 1200？mg/m2 cyclophosphamide on day 1; 2？mg/m2 vindesine and 10？mg bleomycin on days 1 and 5; and 60？mg/m2 prednisone on days 1–5) demonstrated that the benefit of rituximab is maintained over the years [1–7]. Currently, R-CHOP is the standard of care for patients with newly diagnosed DLBCL [8, 9]. The International Prognostic Index (IPI) is commonly used to predict patient outcome and to stratify patients into low- and high-risk groups to choose the appropriate therapeutic treatment [10]. The IPI is based on 5 characteristics, age, performance status (PS), lactic dehydrogenase (LDH) levels, Ann Arbor stage, and extranodal sites, and identifies 4 risk categories of patients with different predicted survival. A simplified score termed the age-adjusted IPI (aaIPI), based on the LDH level, Ann Arbor stage, and PS, has been developed and is widely used to direct therapeutic decision in both the younger and elderly patients. Recent epidemiologic data has confirmed that
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