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Bone marrow (BM), a frequent extranodal involvement site, contains both red and fatty yellow marrow. We investigated whether obesity influences HL outcomes and characterized the BM and cytokine profiles. In this retrospective study, HL patients were analyzed to assess the association between obesity with relapse and mortality. Yellow and red marrow composition were evaluated using CT imaging and correlated with HL outcomes. A nested study analyzed cytokines in the interstitial marrow fluid (IMF) and in circulation of HL patients, in comparison to a control group of healthy blood donors. Further, in\u00a0vitro functional analyses were performed. Overweight\/obesity in HL patients was associated with lower rates of BM involvement, disease relapse, and mortality. Moreover, dense yellow marrow was related to increased risk of death. HL subjects had elevated levels of adiponectin in IMF compared to marrow donors, whereas higher insulin, interleukin 8, and osteoprotegerin levels in IMF were associated with shorter time to relapse. At the molecular level in BM, HL patients had overexpression of\n                    <jats:italic>LEPR<\/jats:italic>\n                    and\n                    <jats:italic>IGFBP3<\/jats:italic>\n                    in adipocytes, while stromal cells overexpressed IGF\u2010axis receptors. In\u00a0in vitro studies, human recombinant IGF\u20101 significantly induced the L428 HL cell line proliferation, which when combined with IGFBP\u20103 modified apoptosis.\n                  <\/jats:p>\n                  <jats:p>The current findings suggest that obesity is associated with a lower incidence of BM involvement and mortality in patients with HL. The obesity together with HL mechanistically influences systemic and local BM cytokine production, thereby impacting HL fate.<\/jats:p>","DOI":"10.1002\/ijc.70480","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T10:43:10Z","timestamp":1776681790000},"page":"782-796","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Systemic and Local Adiposity in the Bone Marrow Microenvironment Associated With Improved Prognosis in Hodgkin Lymphoma: Imaging and Molecular Analysis"],"prefix":"10.1002","volume":"159","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1551-9465","authenticated-orcid":false,"given":"Andreia","family":"Matos","sequence":"first","affiliation":[{"name":"Tumour &amp; Microenvironment Interactions Group, i3S \u2013 Instituto de Investiga\u00e7\u00e3o e Inova\u00e7\u00e3o em Sa\u00fade University of Porto  Porto Portugal"},{"name":"ICBAS \u2013 Instituto de Ci\u00eancias Biom\u00e9dicas Abel Salazar University of Porto  Porto Portugal"},{"name":"Genetics Laboratory, Faculdade de Medicina Universidade de Lisboa  Lisboa Portugal"},{"name":"Institute of Preventive Medicine and Public Health, Faculdade de Medicina Universidade de Lisboa  Lisboa Portugal"},{"name":"Ecogenetics and Human Health, Environmental Health Institute, Faculdade de Medicina Universidade de Lisboa  Lisboa Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William P.","family":"Cawthorn","sequence":"additional","affiliation":[{"name":"University\/BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute, Edinburgh BioQuarter 47 Little France Crescent  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joana","family":"Marinho\u2010Dias","sequence":"additional","affiliation":[{"name":"Laboratory of Virology, Portuguese Institute of Oncology Porto (IPO Porto)  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Ramalheira","sequence":"additional","affiliation":[{"name":"Department of Hematology Vila Nova de Gaia\/Espinho Hospital Center  Vila Nova de Gaia Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susana","family":"Roncon","sequence":"additional","affiliation":[{"name":"Department of Cellular Therapy, Portuguese Institute of Oncology Porto (IPO Porto)  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dulcineia","family":"Pereira","sequence":"additional","affiliation":[{"name":"Department of Onco\u2010Hematology, Portuguese Institute of Oncology Porto (IPO Porto)  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Department of Onco\u2010Hematology, Portuguese Institute of Oncology Porto (IPO Porto)  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Department of Onco\u2010Hematology, Portuguese Institute of Oncology Porto (IPO Porto)  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e1rio","family":"Mariz","sequence":"additional","affiliation":[{"name":"Department of Onco\u2010Hematology, Portuguese Institute of Oncology Porto (IPO Porto)  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Miranda","sequence":"additional","affiliation":[{"name":"Department of Clinical Pathology Centro Hospitalar Universit\u00e1rio Lisboa Norte  Lisboa Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Br\u00edzido","sequence":"additional","affiliation":[{"name":"ULS Viseu D\u00e3o\u2010Laf\u00f5es, Clinical Pathology R. 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