Background High intensity treatments such as hematopoietic cell transplantation (HCT) can be curative for patients with hematologic malignancies, but this needs to be balanced by the high risk of nonrelapse mortality (NRM) during the first 2 years after HCT. Sarcopenia (low muscle mass) is associated with physical disability and premature mortality in individuals with nonmalignant diseases and may be a predictor of NRM and poor overall survival in patients undergoing HCT. Methods This was a retrospective cohort study of 859 patients with acute leukemia or myelodysplastic syndrome who underwent a first HCT as adults (≥18 years) between 2007 and 2014. Sarcopenia was assessed from pre-HCT abdominal computed tomography scans. Two-year cumulative incidence of NRM was calculated, with relapse/progression considered as a competing risk event. Fine-Gray subdistribution hazard ratio estimates and 95% confidence intervals (CI) were obtained and adjusted for relevant covariates. Kaplan-Meier method was used to examine overall survival. All statistical tests were two-sided. Results Median age at HCT was 51 years (range = 18–74 years); 52.5% had a high [≥3] HCT-comorbidity index; 33.7% had sarcopenia pre-HCT. Sarcopenia was an independent predictor of higher NRM risk (hazard ratio = 1.58, 95% CI = 1.16 to 2.16) compared with patients who were not. The 2-year incidence of NRM approached 30% in patients with sarcopenia and high (≥3) HCT-comorbidity index. Patients with sarcopenia had on average a longer hospitalization (37.2 days vs 31.5 days, P < .001) and inferior overall survival at 2 years (55.2%, 95% CI = 49.5% to 61.0% vs 66.9%, 95% CI = 63.0% to 70.8%, P < .001). Conclusions Sarcopenia is an important and independent predictor of survival after HCT, with potential additional downstream impacts on health-economic outcomes. This information can be used to facilitate treatment decisions prior to HCT and guide interventions to decrease the risk of treatment-related complications after HCT.

Childhood cancer survivors are at risk for anthracycline-related cardiac dysfunction, often developing at a time when they are least engaged in long-term survivorship care. New paradigms in survivorship care and chronic disease screening are needed in this population. We compared the accuracy of a novel handheld mHealth platform (Vivio) as well as echocardiography for assessment of cardiac function [left ventricular ejection fraction (EF)] in childhood cancer survivors with cardiac magnetic resonance (CMR) imaging (reference). Cross-sectional study design was used. Concurrent evaluation of EF was performed using Vivio, two-dimensional (2D) echocardiography, and CMR. Differences in mean EF (2D echocardiography vs. CMR; Vivio vs. CMR) were compared using Bland-Altman plots. Linear regression was used to evaluate proportional bias. A total of 191 consecutive survivors participated [50.7% female; median time from diagnosis: 15.8 years (2-44); median anthracycline dose: 225 mg/m (25-642)]. Echocardiography overestimated mean EF by 4.9% ( < 0.001); linear regression analysis confirmed a proportional bias, when compared with CMR ( = 3.1, < 0.001). There was no difference between mean EF derived from Vivio and from CMR (-0.2%, = 0.68). The detection of cardiac dysfunction via echocardiography was poor when compared with CMR [Echo EF< 45% (sensitivity 14.3%), Echo EF < 50% (sensitivity 28.6%)]. Sensitivity was substantially better for Vivio-based measurements [EF < 45% or EF < 50% (sensitivity 85.7%)]. This accessible technology has the potential to change the day-to-day practice of clinicians caring for the large number of patients diagnosed with cardiac dysfunction and heart failure each year, allowing real-time monitoring and management of their disease without the lag-time between imaging and interpretation of results. .

Background The number of patients undergoing autologous haematopoietic cell transplant (HCT) is growing, but little is known about the factors that predict adverse outcomes. Low muscle mass and obesity are associated with disability and premature mortality in individuals with non‐malignant diseases and may predict outcomes after autologous HCT. Methods This was a retrospective cohort study of 320 patients who underwent autologous HCT for Hodgkin or non‐Hodgkin lymphoma between 2009 and 2014. Sarcopenia {skeletal muscle index male: <43 cm/m 2 [body mass index (BMI) < 25 kg/m 2 ] or < 53 cm/m 2 [BMI ≥ 25 kg/m 2 ] and female: <41 cm/m 2 [regardless of BMI]) and obesity [total abdominal adiposity ≥450.0 cm 2 (male), ≥396.4 cm 2 (female)] were assessed from single‐slice abdominal pre‐HCT computed tomography images. Length of hospital stay, first unplanned intensive care unit admission, and 30‐day unplanned readmission were evaluated based on body composition using multivariable regression analysis, and mortality was evaluated with Kaplan–Meier analysis and Gray's test. Results Median age at HCT was 53.3 years (range, 18.5 to 78.1 years); 26.3% were sarcopenic and an additional 7.8% were sarcopenic obese pre‐HCT. Sarcopenic obesity was associated with increased risk of prolonged hospitalization [odds ratio (OR) = 3.6, 95% confidence interval (CI) 1.3–9.8], intensive care unit admission (OR = 4.7, 95% CI 1.5–16.1), and unplanned readmission after HCT (OR = 13.6, 95% CI 2.5–62.8). Patients who were sarcopenic obese also had the highest mortality risk at 1 year [hazard ratio (HR): 3.9, 95% CI 1.1–11.0] and 5 years (HR: 2.5, 95% CI 1.1–5.5), compared with patients with normal body composition. Sarcopenia alone, but not obesity alone, was associated with an increased risk of these outcomes, albeit with a lower magnitude of risk than in patients who were sarcopenic obese. Conclusions Sarcopenic obesity was an important predictor of outcomes in patients undergoing autologous HCT. These findings could inform targeted prevention strategies in patients at highest risk of complications after HCT.

In these long-term survivors, there was a high rate of cardiac dysfunction that was independent of HCT status. The growing number of lymphoma survivors makes it imperative to identify reliable and cost-effective strategies to decrease the burden of heart failure in this population. Cancer 2018;124:850-7. © 2017 American Cancer Society.

Reactivation of varicella zoster virus (VZV) can occur in 20-53% of patients during the first year after allogeneic HCT, contributing to a high burden of infectious complications after HCT, and increasing utilization of medical resources and healthcare costs [1]. Accordingly, current guidelines recommend antiviral prophylaxis (e.g., acyclovir) for a minimum of 1 year after HCT, or until discontinuation of immunosuppression, whichever occurs later [1]. The recommended dose of acyclovir (800 mg twice daily [BID]) was derived from at least two randomized studies that demonstrated efficacy (≤5% reactivation) in the first year after HCT [1,2]. However, this strategy is limited by a high risk of nephrotoxicity brought on by the concurrent use of antimicrobials or immunosuppressive medications used to treat graft versus host disease (GVHD) [1]. Currently, there is variability in clinical practice across transplant centers, with studies suggesting short-term efficacy of lower dose acyclovir in solid organ transplant and select patients undergoing HCT [3,4]. As such, VZV prophylaxis at our institution has been acyclovir 400 mg BID, with a duration of at least 1 year after HCT or 3 months after discontinuation of immunosuppressive medications, whichever occurs later. The long-term efficacy of this approach has not been well-described.We conducted a retrospective cohort study of patients who underwent allogenic HCT as adults (≥18 years old) at City of Hope (COH) between January 1, 2010 and December 31, 2015. COH and non-COH medical records were the primary source of information. We abstracted demographic data (age at HCT, sex, race/ethnicity), CMV serostatus, diagnosis (acute myeloid leukemia [AML], acute lymphoid leukemia [ALL], myelodysplastic syndrome [MDS], other), HCT comorbidity-age index (HCT-CI), Karnofsky performance score (KPS), HCT details (donor source, conditioning intensity [5]), relapse risk at HCT [6], severity of acute GVHD, and vital status per an established protocol [7,8]. GVHD prophylaxis was tacrolimus/sirolimus-based or tacrolimus with a short course of methotrexate. Grading of acute GVHD was per established criteria [9]. The Institutional Review Board at COH approved the protocol. Informed consent was provided according to the Declaration of Helsinki.The primary endpoint was VZV infection, categorized as dermatomal (involvement of 1-2 dermatomes) or disseminated (involvement of >2 dermatomes or extracutaneous involvement) per established definitions [10]. Patients were followed until the first episode of VZV infection or a competing risk event, whichever occurred first.Univariate analyses were performed to compare between patients who developed VZV and those who did not. Relapse/ progression or death was considered as a competing event. Time was calculated from the date of HCT to date of death, relapse/progression, or last contact (censored: December 31, 2018). Cumulative incidence of VZV infection was calculated taking into consideration competing risk for right-censored data [11]. Multivariable log...