Impact of Anthracyclines on Diabetes Mellitus Development in B-Cell Lymphoma Patients: A Nationwide Population-based Study

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.