Abnormal body composition is a predictor of adverse outcomes after autologous haematopoietic cell transplantation

Abstract

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.

Sarcopenia and preserved bone mineral density in paediatric survivors of high‐risk neuroblastoma with growth failure

“…In addition, low physical activity and nutritional deficiency as an effect of treatment may also contribute to sarcopenia. Our findings are in line with the presence of sarcopenia in other recipients of ASCT such as Hodgkin or non‐Hodgkin lymphoma 17 . The identification of sarcopenic obesity in these survivors was also associated with increased mortality risk at 1 year and at 5 years after ASCT compared with patients with normal body composition 17 .…”

“…Therapy for HR‐NBL remains a highly intense, multi‐agent treatment regimen, and no singular treatment primarily contributes to the sarcopenia in HR‐NBL survivors. Recipients of bone marrow transplant who receive similar chemotherapy and radiation regimens demonstrate comparable lasting deficits 17,24 . In addition, low physical activity and nutritional deficiency as an effect of treatment may also contribute to sarcopenia.…”

“…Survivors of HR‐NBL have numerous risk factors for abnormal body composition, such as nutritional deficiencies and endocrine abnormalities as a consequence of chemotherapy, ASCT and radiation 6 . Sarcopenia is the progressive loss of muscle mass and function caused by ageing, disease and inactivity; it is associated with physical disability and premature mortality in survivors of ASCT 15–17 . Sarcopenia has been demonstrated in other populations of cancer survivors 17,18 .…”

“… 6 Sarcopenia is the progressive loss of muscle mass and function caused by ageing, disease and inactivity; it is associated with physical disability and premature mortality in survivors of ASCT. 15 , 16 , 17 Sarcopenia has been demonstrated in other populations of cancer survivors. 17 , 18 Most studies describing body composition abnormalities in survivors of childhood cancer include a small number of patients and an insufficiently robust control population necessary to characterize body composition relative to age, sex, race, maturation and body size.…”

“… 15 , 16 , 17 Sarcopenia has been demonstrated in other populations of cancer survivors. 17 , 18 Most studies describing body composition abnormalities in survivors of childhood cancer include a small number of patients and an insufficiently robust control population necessary to characterize body composition relative to age, sex, race, maturation and body size. As a result, abnormalities in body composition in long‐term survivors of HR‐NBL have not been well characterized.…”