Prognostic impact of sarcopenia in patients with diffuse large B‐cell lymphoma treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone

Abstract

BackgroundSarcopenia is known to be related to an increased risk of chemotherapy toxicity and to a poor prognosis in patients with malignancy. We assessed the prognostic role of sarcopenia in patients with diffuse large B‐cell lymphoma (DLBCL).MethodsIn total, 187 consecutive patients with DLBCL treated with induction rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R‐CHOP) immunochemotherapy were reviewed. Sarcopenia was defined as the lowest sex‐specific quartile of the skeletal muscle index, calculated by dividing the pectoralis muscle area by the height. Clinical outcomes were compared between the sarcopenic and non‐sarcopenic groups. A nomogram was constructed from the Cox regression model for overall survival (OS).ResultsTreatment‐related mortality (21.7 vs. 5.0%, P = 0.002) and early discontinuation of treatment (32.6 vs. 14.9%, P = 0.008) were more common in the sarcopenic group than in the non‐sarcopenic group. The 5 year progression‐free survival (PFS) rates were 35.3% in the sarcopenic group and 65.8% in the non‐sarcopenic group (P < 0.001). The 5 year OS rates were 37.3% in the sarcopenic group and 68.1% in the non‐sarcopenic group (P < 0.001). Sarcopenia and the five variables of the International Prognostic Index (IPI) were independent prognostic factors in a multivariate analysis for PFS and OS and were used to construct the nomogram. The calibration plot showed good agreement between the nomogram predictions and actual observations. The c index of the nomogram (0.80) was higher than those of other prognostic indices (IPI, 0.77, P = 0.009; revised‐IPI, 0.74, P < 0.001; National Comprehensive Cancer Network‐IPI, 0.77, P = 0.062).ConclusionsSarcopenia is associated with intolerance to standard R‐CHOP chemotherapy as well as a poor prognosis. Moreover, sarcopenia itself can be included in prognostic models in DLBCL.

Pre‐operative core muscle index in combination with hypoalbuminemia is associated with poor prognosis in advanced ovarian cancer

“…With this in mind, our results contrast what is observed in other malignancies where low muscle mass alone was associated with worse overall survival and greater post‐operative morbidity . Most studies in other malignancies have found an impact of low muscle mass on overall survival, but only a few studies observed differences in progression‐free survival . In several malignancies, low muscle mass has been demonstrated to be strong predictor of both short‐ and long‐term outcomes .…”

“…11,13,34,35 Most studies in other malignancies have found an impact of low muscle mass on overall survival, but only a few studies observed differences in progression-free survival. [36][37][38] In several malignancies, low muscle mass has been demonstrated to be strong predictor of both short-and long-term outcomes. 34,35,39,40 We may have identified differences in PFS had our patient cohort been more diverse in stage and presentation.…”

Muscle wasting and sarcopenia in heart failure and beyond: update 2017

“…19 A gender-specific effect was also seen in a rat model of ageing with males being more prone to muscle loss, particularly when fed a high fat diet. 23 Sarcopenia is also associated with standard R-CHOP chemotherapy intolerance in patients with malignancies 24 and worse survival of patients with ovarian cancer receiving neoadjuvant chemotherapy. 25…”

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

“…Sarcopenia, or the presence of low muscle mass, has been associated with decreased overall survival in patients with DLBCL [3–5]. However, the impact of sarcopenia on other outcomes, including treatment toxicity, treatment-related mortality, and ability to complete standard therapy, has not been well-studied in the DLBCL population.…”