Evolution of Body Composition Following Autologous and Allogeneic Hematopoietic Cell Transplantation: Incidence of Sarcopenia and Association with Clinical Outcomes

Abstract

Sarcopenia, the loss of muscle mass, has been identified as a potential risk factor for adverse outcomes in hematopoietic cell transplantation (HCT) recipients. However, much remains unknown about change in body composition following HCT. We retrospectively evaluated computed tomography (CT) imaging from 315 lymphoma patients undergoing HCT at our institution between 2000 and 2014. Cross-sectional areas of lean muscle, subcutaneous adipose tissue, and visceral adipose tissue were measured on CT at the level of the third lumbar vertebral body before HCT, 1-year post-HCT, and 2.5 years post-HCT. The incidence of sarcopenia before HCT was 47% in the autologous HCT (auto-HCT) cohort (n = 218) and 55% in the allogeneic HCT (allo-HCT) cohort (n = 97). Older age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01 to 1.04; P < .001) and male sex (OR, 4.59; 95% CI, 1.42 to 4.93; P < .001) were associated with sarcopenia before HCT. Increasing body mass index (OR, .78; 95% CI, .73 to .84; P < .001) was protective against sarcopenia before HCT. A significant decline in total lean body mass (β = 1.96; 95% CI, .79 to 3.13; P = .001) and increased sarcopenia incidence (OR, 1.72; 95% CI, 1.13 to 2.62, P = .012) was observed over time for patients in the allo-HCT cohort when compared with the trend in the auto-HCT cohort. Both auto-HCT and allo-HCT recipients experienced an increase in total body fat mass over time (β = 3.75; 95% CI, 2.77 to 4.73; P < .001). In multivariate analysis of patients undergoing allo-HCT, the presence of sarcopenia on baseline imaging before HCT was associated with a lower risk of acute graft-versus-host disease (OR, .30; 95% CI, .09 to .98; P = .047). In conclusion, we found that total body fat mass increases after both auto-HCT and allo-HCT. Following allo-HCT, total lean body mass significantly decreases corresponding to increased incidence of sarcopenia. Future studies are needed to further characterize changes in body composition in HCT recipients and investigate its impact on HCT outcomes.

Risks of Muscle Atrophy in Patients with Malignant Lymphoma after Autologous Stem Cell Transplantation

“…There were several reports with regards to changes in skeletal muscle mass and the effects of exercise therapy after HSCT 14 ) . The association between skeletal muscle reduction clinical outcomes and prognosis after HSCT has also been suggested in the previous reports 13,15,16) . While patients with hematological malignancies are treated with HSCT, the influence of HSCT on skeletal muscle mass have not been previously described in detail despite the known relationship between auto-HSCT and muscle atrophy.…”

“…Skeletal muscle mass was measured by diagnostic CT scans at L3, as previously described 16) . The CT scans used for analysis were carried out as part of the ML assessment.…”

“…The CT scans were obtained and evaluated for body com-position data by two government-certified physical therapists who were blinded to the patients' information under the guidance of a diagnostic radiologist. Skeletal muscle mass was evaluated by the psoas muscle index (PMI) index, and PMI was calculated by normalizing the L3 psoas muscle areas by the square of the height (m 2 ) 16 ) . This analysis was performed using the diagnostic software ImageJ 17 ) .…”

Prognostic impact of low muscle mass and low muscle density in patients with diffuse large B-cell lymphoma

“…In a longitudinal retrospective study of 342 DLBCL survivors, the prevalence of LMM after chemotherapy was 37.9%, whereas 20.7% of these patients did not have LMM at the start of treatment [27]. In another study with DLBCL patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT), the prevalence of LMM was 55% at baseline and 75% 2.5 years after allogeneic HSCT [28]. In these studies, the development of LMM after chemotherapy was associated with higher age, >5% weight loss during chemotherapy and having LMM at baseline, therefore possibly indicating vulnerable patients.…”

Effect of Treatment on the Muscle Mass and Response to Therapy in Hodgkin’s Lymphoma

“…Toplam vücut yağ kitlesi, hem otolog hem de allojeneik kök hücre naklinden sonra artmıştır. Allojeneik kök hücre naklini takiben, toplam yağsız vücut kitlesi anlamlı ölçüde azalmış, sarkopeni insidansı artmıştır (14).…”