Evaluation of the impact of cachexia on clinical outcomes in aggressive lymphoma

Burkart, Madelyn; Schieber, Michael; Basu, Sanjib; Shah, Palmi; Venugopal, Parameswaran; Borgia, Jeffrey A.; Gordon, Leo I.; Karmali, Reem

doi:10.1111/bjh.15889

Cited by 38 publications

(26 citation statements)

References 31 publications

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“…The impact of cancer cachexia on clinical outcomes has been evaluated in males versus females. For example, Burkart et al [30] investigated a cohort of 109 patients with aggressive B cell lymphoma. They reported that both progression-free survival (PFS) and overall survival (OS) were decreased in males with sarcopenia compared with those without and that males with adipopenia had decreased OS compared with the non-adipopenic group.…”

Section: Sex Difference In Cancer Cachexia Phenotypesmentioning

confidence: 99%

Sex Differences in Cancer Cachexia

Zhong

Zimmers

2020

Curr Osteoporos Rep

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Purpose of Review Cachexia, a feature of cancer and other chronic diseases, is marked by progressive weight loss and skeletal muscle wasting. This review aims to highlight the sex differences in manifestations of cancer cachexia in patients, rodent models, and our current understanding of the potential mechanisms accounting for these differences. Recent Findings Male cancer patients generally have higher prevalence of cachexia, greater weight loss or muscle wasting, and worse outcomes compared with female cancer patients. Knowledge is increasing about sex differences in muscle fiber type and function, mitochondrial metabolism, global gene expression and signaling pathways, and regulatory mechanisms at the levels of sex chromosomes vs. sex hormones; however, it is largely undetermined how such sex differences directly affect the susceptibility to stressors leading to muscle wasting in cancer cachexia. Summary Few studies have investigated basic mechanisms underlying sex differences in cancer cachexia. A better understanding of sex differences would improve cachexia treatment in both sexes.

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Section: Sex Difference In Cancer Cachexia Phenotypesmentioning

confidence: 99%

Sex Differences in Cancer Cachexia

Zhong

Zimmers

2020

Curr Osteoporos Rep

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“…Given the high tumor burden of DLBCL and the favorable response rate with substantial treatmentrelated toxicities of R-CHOP treatment, the prognostic role of cancer cachexia is also likely to be observed in DLBCL patients. Several markers for malnutrition and cachexia such as body mass index (BMI), sarcopenia, adipopenia, and serum albumin level have been studied and suggested to be prognostic factors in DLBCL [14][15][16][17]. Additionally, the clinical value of the Geriatric Nutritional Risk Index (GNRI), which was originally developed to predict nutrition-related morbidity and mortality in non-cancer patients [18], was evaluated in two previous DLBCL studies with conflicting results [19,20].…”

Section: Introductionmentioning

confidence: 99%

Prognostic model based on the geriatric nutritional risk index and sarcopenia in patients with diffuse large B-cell lymphoma

Kim

Kang

et al. 2020

BMC Cancer

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Background: Systemic inflammation and cachexia are associated with adverse clinical outcomes in diffuse large Bcell lymphoma (DLBCL). The Geriatric Nutritional Risk Index (GNRI) is one of the main parameters used to assess these conditions, but its efficacy in DLBCL is inconclusive. Methods: We retrospectively reviewed 228 DLBCL patients who were treated with R-CHOP immunochemotherapy (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone). The patients were stratified according to GNRI score (> 98, 92 to 98, 82 to < 92, and < 82) as defined in previous studies. Additionally, the extent of sarcopenia was categorized as sarcopenia-both, sarcopenia-L3/PM alone, and non-sarcopenia-both according to skeletal muscle index. Results: Survival curves plotted against a combination of GNRI and sarcopenia scores revealed two clear groups as follows: high cachexia risk (HCR) group (GNRI < 82, sarcopenia-both, or GNRI 82-92 with sarcopenia-L3/PM alone) and low cachexia risk (LCR) group (others). The HCR group had a lower complete response rate (46.5% vs. 86.6%) and higher frequency of treatment-related mortality (19.7% vs. 3.8%) and early treatment discontinuation (43.7% vs. 8.3%) compared with the LCR group. The median progression-free survival (PFS) (not reached vs. 10.3 months, p < 0.001) and overall survival (OS) (not reached vs. 12.9 months, p < 0.001) were much shorter in the HCR group than in the LCR group. On multivariable analyses, the HCR group was shown to be an independent negative prognostic factor for PFS and OS after adjusting the National Comprehensive Cancer Network-International Prognostic Index (NCCN-IPI). Conclusions: A combined model of GNRI and sarcopenia may provide prognostic information independently of the NCCN-IPI in DLBCL.

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“…Some authors found that a decreased muscle mass was independently associated with lower overall survival and progression-free survival in DLBCL patients (5,(7)(8)(9). Others confirmed this result in male patients only (10,11), while Chu et al (6,12) described a trend toward an improved survival in patients with lower SMI.…”

Section: Introductionmentioning

confidence: 95%

Prognostic Impact of Muscle Quantity and Quality and Fat Distribution in Diffuse Large B-Cell Lymphoma Patients

et al. 2021

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Baseline CT scans of 116 patients (48% female, median 64 years) with diffuse large B-cell lymphoma (DLBCL) were retrospectively reviewed to investigate the prognostic role of sarcopenia and fat compartment distributions on overall survival (OS), progression-free survival (PFS), and early therapy termination. Skeletal muscle index (SMI), skeletal muscle density (SMD), and intermuscular adipose tissue (IMAT) were quantified at the level of the third lumbar vertebra (L3) and proximal thigh (PT). Low L3-SMD, but not low L3-SMI, was associated with early therapy termination (p = 0.028), shorter OS (HR = 6.29; 95% CI = 2.17–18.26; p < 0.001), and shorter PFS (HR = 2.42; 95% CI = 1.26–4.65; p = 0.008). After correction for sex, International Prognostic Index (IPI), BMI, and R-CHOP therapy (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), low L3-SMD remained associated with poor OS (HR = 3.54; 95% CI = 1.10–11.40; p = 0.034) but not with PFS. Increased PT-IMAT was prognostic for poor OS and PFS after correction for sex, IPI, BMI, and R-CHOP therapy (HR = 1.35; CI = 1.03–1.7; p = 0.03, and HR = 1.30; CI = 1.04–1.64; p = 0.024, respectively). Reduced muscle quality (SMD) and increased intermuscular fat (IMAT), rather than low muscle quantity (SMI), are associated with poor prognosis in DLBCL, when measured at the L3 level, and particularly at the level of the proximal thigh. The proximal thigh represents a novel radiological landmark to study body composition.

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Evaluation of the impact of cachexia on clinical outcomes in aggressive lymphoma

Cited by 38 publications

References 31 publications

Sex Differences in Cancer Cachexia

Sex Differences in Cancer Cachexia

Prognostic model based on the geriatric nutritional risk index and sarcopenia in patients with diffuse large B-cell lymphoma

Prognostic Impact of Muscle Quantity and Quality and Fat Distribution in Diffuse Large B-Cell Lymphoma Patients

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