Prognostic impact of the psoas muscle index, a parameter of sarcopenia, in patients with diffuse large B-cell lymphoma treated with rituximab-based chemoimmunotherapy

Iltar, Utku; Sözel, Hasan; Sözel, Yıldız Kilar; Ataş, Ünal; Yücel, Orhan Kemal; Salim, Ozan; Aydın, Funda; Ündar, Levent

doi:10.1080/10428194.2020.1856833

Cited by 24 publications

(25 citation statements)

References 31 publications

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“…Sarcopenia (low SMI), malnutrition (hypoalbuminaemia), and systemic inflammation (high NLR) are key components of cancer cachexia, each of which is also related to worse clinical outcomes in patients with DLBCL. Sarcopenia is associated with shorter survival, reduced response to treatment, increased treatment‐related toxicities, frequent dose reduction, and early termination of treatment 13,24–27 . Hypoalbuminaemia is a predictive factor for shorter survival, decreased relative dose intensity of anthracycline and cyclophosphamide, and increased risk of TRM 28–32 .…”

Section: Discussionmentioning

confidence: 99%

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Cachexia index as a potential biomarker for cancer cachexia and a prognostic indicator in diffuse large B‐cell lymphoma

Park

et al. 2021

J cachexia sarcopenia muscle

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Background Cancer cachexia is known to adversely affect the clinical course in patients with malignant lymphoma. The cachexia index (CXI) is a potential biomarker of cancer cachexia, and its implications for the prognosis and treatment outcome of lung cancer and aggressive lymphoma has been assessed in previous studies. Methods A total of 267 patients diagnosed with diffuse large B‐cell lymphoma who were treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R‐CHOP) immunochemotherapy were retrospectively reviewed. The CXI was calculated as the skeletal muscle index (SMI) × serum albumin/neutrophil–lymphocyte ratio (NLR). Although previous studies measured the SMI using the muscles of the L3 vertebral level, the present study used both the L3 vertebral muscles and the pectoralis muscles (PM) at the T4 vertebral level to measure the SMI. Depending on the type of muscles used, the CXI was termed the L3‐CXI or PM‐CXI. Using sex‐specific cutoff values for CXI, the patients were categorized as follows: (i) high‐CXI group (high L3‐CXI and high PM‐CXI), (ii) intermediate‐CXI group (high L3‐CXI and low PM‐CXI), and (iii) low‐CXI group (low L3‐CXI and low PM‐CXI). Results Complete responses to R‐CHOP were obtained in 145/173 (83.8%), 25/36 (69.4%), and 27/57 (47.4%) patients in the high‐CXI, intermediate‐CXI, and low‐CXI groups, respectively (P < 0.001). Treatment‐related anaemia (15.6%, 30.6%, and 26.3%, P = 0.038), thrombocytopenia (21.4%, 36.1%, and 43.9%, P < 0.001), febrile neutropenia (23.7%, 44.4%, and 36.8%, P = 0.022), and any nonhaematologic toxicity (31.2%, 44.4%, and 54.4%, P = 0.001) of Grade 3 or more were more common in the lower CXI groups than in the higher‐CXI groups. Early treatment discontinuation for reasons other than lymphoma progression also occurred more frequently in the low‐CXI group (24/57, 42.1%) compared with the intermediate‐CXI (5/36, 13.9%) and high‐CXI (18/173, 10.4%) groups (P < 0.001). Median overall survival in the high‐CXI, intermediate‐CXI, and low‐CXI groups was not reached, 50.6 months, and 14.5 months, respectively (p < 0.001). Multivariable analysis showed that low CXI was an independent negative prognostic factor for overall survival (hazard ratio 2.103, 95% confidence interval 1.278–3.460, P = 0.003). Conclusions We suggest that in patients with diffuse large B‐cell lymphoma, the CXI is a biomarker for cancer cachexia that can predict survival, treatment response, treatment‐related toxicity, and compliance with R‐CHOP. Patients were more clearly stratified by this new CXI category compared with the classifications described in previous studies.

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Section: Discussionmentioning

confidence: 99%

“…Currently, cachexia is not used as a prognostic factor in standard prognostic systems for malignant lymphoma 3–6 . However, several biomarkers and indices of cachexia have been suggested to be related to the clinical outcome of patients with malignant lymphoma 7–13 . For example, Karmali et al .…”

Section: Introductionmentioning

confidence: 99%

Cachexia index as a potential biomarker for cancer cachexia and a prognostic indicator in diffuse large B‐cell lymphoma

Park

et al. 2021

J cachexia sarcopenia muscle

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“…Associations of tumor cachexia and reduced muscle mass present at baseline with adverse clinical outcomes are well described in patients with various solid and hematologic malignancies. 7 , 8 , 13–16 In cohorts of R-CHOP-treated DLBCL patients, patients presenting with sarcopenia prior to immunochemotherapy were shown to have worse OS and PFS. 8 , 13 , 14 , 16 , 17 However, as we have previously reported, 18 immunochemotherapeutic regimens like R-DA-EPOCH might moderate these associations through personalized dose adjustments tailored to the hematopoietic reserve.…”

Section: Discussionmentioning

confidence: 99%

“…7 , 8 , 13–16 In cohorts of R-CHOP-treated DLBCL patients, patients presenting with sarcopenia prior to immunochemotherapy were shown to have worse OS and PFS. 8 , 13 , 14 , 16 , 17 However, as we have previously reported, 18 immunochemotherapeutic regimens like R-DA-EPOCH might moderate these associations through personalized dose adjustments tailored to the hematopoietic reserve. Despite being associated with older age, female gender and worse R-IPI stage, baseline psoas muscle index did not affect response to therapy or survival outcomes in our cohort of patients.…”

Section: Discussionmentioning

confidence: 99%

More Pronounced Muscle Loss During Immunochemotherapy is Associated with Worse Clinical Outcomes in Newly Diagnosed Patients with Diffuse Large B-Cell Lymphoma with Unfavorable Features

Lucijanić¹,

Korunić²,

Sedinić³

et al. 2021

TCRM

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Introduction Cancer-induced cachexia is associated with poor prognosis in patients with non-Hodgkin lymphoma, but it is unknown how and to what extent curable lymphoma treatments affect the musculoskeletal system. Patients and Methods We retrospectively analyzed 104 newly diagnosed diffuse large B-cell lymphoma (DLBCL) patients with unfavorable disease features treated with the R-DA-EPOCH regimen. Psoas muscle area (PMA) measured at L3 vertebra level was compared between staging (pre-therapy) and revision (end of treatment) computerized tomography (CT) scans. Results Small but significant decline in PMA was observed during the immunochemotherapy period (average loss 5%; P =0.016) with 57.7% of patients experiencing muscle loss. Higher body surface area (OR=17.98 for each m 2 ; P =0.034), number of cycles with dose reduction (OR=2.86 for each cycle; P =0.039) and worse response to therapy (OR=3.09 for each response category; P =0.052) were recognized as independent contributors to the PMA loss in multivariate analysis. One quarter of patients had more pronounced PMA loss (≥21%), which was associated with significantly worse overall and progression-free survival. Both ≥21% PMA loss and non-achieving response to therapy remained independently associated with inferior OS (PMA loss HR=2.98; P =0.016 and achieving response HR=0.04; P <0.001) and PFS (PMA loss HR=3.16; P =0.005 and achieving response HR=0.08; P =0.001) in multivariate analyses. Discussion Muscle loss occurs in approximately half of newly diagnosed DLBCL patients with unfavorable disease features during R-DA-EPOCH immunochemotherapy. If pronounced, this is associated with worse clinical outcomes irrespectively of achieved response to therapy. Muscle loss seems to be mostly affected by the efficacy and tolerability of the regimen.

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“…Researchers use CT images at the third lumbar level (L3) to assess body composition because it is correlated with the estimated total lean body skeletal muscle mass (11)(12)(13)(14). This method also makes it possible to measure SMD.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Skeletal Muscle Radiodensity and Psoas Muscle Index on Prognosis of Small-Cell Lung Cancer

Sözel¹,

Beypınar²,

Sözel³

et al. 2021

esmj

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Introduction: Small cell lung cancer (SCLC) has a poor prognosis and accounts for about 15% of all lung cancer cases. This study was planned to investigate the prognostic value of skeletal muscle radiodensity (SMD) and psoas muscle index (PMI) in patients with SCLC. Methods: The archive records of 253 patients with SCLC were retrospectively analyzed and 106 of them were included in the study. The overall survival (OS) and body mass index of the patients were calculated. The images of computed tomography (CT) at the time of diagnosis were retrieved for analysis. The cross-sectional area and the mean radiodensity of the psoas muscle at the third lumbar vertebral level on CT scan were measured for assessing SMD and PMI. Results: While fifty-seven of 106 patients had an extensive disease, 49 patients were considered as the limited stage. SMD was significantly lower in patients with extensive disease. While OS was significantly different for low and high SMD groups, no difference was observed between them according to PMI categories. The median OS was 8 and 12 months in low and high SMD groups, respectively. In multivariate analysis, SMD remained a significant prognostic factor in terms of stage and age at diagnosis. Conclusion:In the present study, it was found that SMD was an independent risk factor for OS, but PMI was not. The combined use of demographic and essential clinical information and SMD can enable to help physicians and patients to predict survival and thereby enhance medical decision making for newly diagnosed SCLC patients.

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Prognostic impact of the psoas muscle index, a parameter of sarcopenia, in patients with diffuse large B-cell lymphoma treated with rituximab-based chemoimmunotherapy

Cited by 24 publications

References 31 publications

Cachexia index as a potential biomarker for cancer cachexia and a prognostic indicator in diffuse large B‐cell lymphoma

Cachexia index as a potential biomarker for cancer cachexia and a prognostic indicator in diffuse large B‐cell lymphoma

More Pronounced Muscle Loss During Immunochemotherapy is Associated with Worse Clinical Outcomes in Newly Diagnosed Patients with Diffuse Large B-Cell Lymphoma with Unfavorable Features

The Effect of Skeletal Muscle Radiodensity and Psoas Muscle Index on Prognosis of Small-Cell Lung Cancer

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