Exploring GLP-1 Receptor Agonists for Weight Loss in Patients with Hematologic Malignancies: Evidence from a Retrospective Cohort
Introduction/Background/Significance: Obesity and metabolic dysfunction are common in patients with hematological malignancies (such as lymphoma, leukemia, myeloma, myelodysplastic syndrome (MDS), and myeloproliferative neoplasms (MPN)) and may be exacerbated by chemotherapy. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are approved for diabetes and obesity management and promote weight loss through appetite suppression, delayed gastric emptying, and enhanced insulin secretion. However, their role in patients with hematological cancers, particularly during chemotherapy, remains underexplored.
Materials and Methods/Case Presentation/Objective: This single-institution retrospective study evaluated adult patients with hematological malignancy (including lymphoma, leukemia, myeloma, MDS, or MPN) who were prescribed GLP-1RAs between 2015 and 2024. Demographics, cancer type, treatment details, and overlap with chemotherapy were recorded. Changes in body mass index (BMI) were analyzed using descriptive statistics. A one-sample t-test assessed overall BMI changes; subgroup analyses (Welch t-tests, linear regression) evaluated the effects of chemotherapy, sex, and cancer type. Statistical analyses were performed using R.
Results/Description/Main Outcome Measures: Eighty-six patients with a hematological malignancy diagnosis were included in the analysis. The median age at GLP-1RA initiation was 60.3 years (IQR: 51.5-67.1) and patients were predominantly treated with semaglutide (50%) and liraglutide (29%) for a median of 11.8 months (IQR: 9.2–23.7). Most patients (94%) had a diabetes indication. Median BMI decreased from 32.4 kg/m2 (IQR: 29.1–38.1) to 30.8 kg/m2 (IQR: 27.7–37.1), with a mean reduction of –1.30 kg/m2 (95% CI: –1.91 to –0.69; p-value < 0.001) and a median percentage decrease of –3.65% (95% CI: –5.42% to –1.88%).
BMI reductions were observed in patients receiving chemotherapy (mean –4.04%, 95% CI: –6.69% to –1.40%) and those not receiving chemotherapy (mean –3.43%, 95% CI: –5.81% to –1.04%), with no significant difference between groups (95% CI: –2.89 to 4.13). BMI reduction did not differ by sex (95% CI: –0.80 to 6.39) or hematological malignancy type (lymphoma, leukemia, myeloma, or other (MDS, MPN); R2 ≤ 0.08, p-value = 0.6396).
Conclusions: GLP-1RA therapy was associated with modest but consistent weight loss in patients with hematological malignancies, irrespective of chemotherapy exposure, sex, or cancer subtype. These results, aligned with GLP-1RA effects at diabetes-appropriate doses, support further prospective studies to evaluate incretin-based therapies for metabolic optimization and potential cancer-specific outcomes in this population.
