Impact of sarcopenia on treatment tolerance in United States veterans with diffuse large B‐cell lymphoma treated with CHOP‐based chemotherapy

Abstract

While sarcopenia has been associated with decreased overall survival in diffuse large B-cell (DLBCL) patients, the impact of sarcopenia on treatment tolerance has not been well-studied. We evaluated the association of sarcopenia with febrile neutropenia hospitalization, treatment-related mortality, and ability to complete standard number of cycles in a retrospective cohort of United States veterans diagnosed with DLBCL between 1998 and 2008 and treated with cyclophosphamide, doxorubicin, vincristine, and prednisone, with or without rituximab. Baseline body composition parameters were evaluated using computed tomography analysis. In total, 522 patients were included in the study, of whom 245 (47%) had baseline sarcopenia. After controlling for other variables, baseline sarcopenia was independently associated with increased risk of febrile neutropenia hospitalization (adjusted Odds Ratio (aOR) 1.64, 95% Confidence Interval (CI) 1.01 to 2.65) and inability to complete standard number of treatment cycles (aOR 1.49, 95% CI 1.02 to 2.16) compared with no baseline sarcopenia. There was a non-statistically significant trend towards higher treatment-related mortality in sarcopenic patients than non-sarcopenic patients (aOR 1.77, 95% CI 0.92 to 3.41). Sarcopenia is associated with increased risk of treatment intolerance and may be useful in guiding treatment planning and supportive care measures.

Treatment approaches for older and oldest patients with diffuse large B-cell lymphoma – Use of non-R-CHOP alternative therapies and impact of comorbidities on treatment choices and outcome: A Humedica database retrospective cohort analysis, 2007–2015

“…The importance of incorporating information from a comprehensive geriatric assessment in initial treatment decisions for older/less fit patients has also been recognized [73][74][75][76][77][78][79][80][81][82]. Data on the impact of factors not captured in traditional performance status measures, as sarcopenia, body mass index, nutritional index, and cachexia on DLBCL outcome are now emerging, and are of special interest in older patients [83][84][85][86][87][88][89][90]. Analyses of DLBCL treatment costs have also been assessed [91].…”

MYD88 p.(L265P) detection on cell‐free DNA in liquid biopsies of patients with primary central nervous system lymphoma

“…Sarcopenia is an increasingly recognised independent risk factor for treatment intolerance (Xiao et al, 2016) and fluid retention may complicate chemotherapy in patients with systemic AL amyloidosis. BIA enables recognition of changes in body composition and further work to assess its role in influencing clinical outcomes in AL amyloidosis is warranted.…”

Bioimpedance vector analysis for the detection of extracellular volume overload and sarcopenia in systemic AL amyloidosis

“…Sarcopenia is an increasingly recognised independent risk factor for treatment intolerance (Xiao et al , ) and fluid retention may complicate chemotherapy in patients with systemic AL amyloidosis. BIA enables recognition of changes in body composition and further work to assess its role in influencing clinical outcomes in AL amyloidosis is warranted.…”