Prognostic relevance of sarcopenia, geriatric, and nutritional assessments in older patients with diffuse large B-cell lymphoma: results of a multicentric prospective cohort study

Abstract

This prospective study aimed to investigate the prognostic effect of sarcopenia, geriatric, and nutritional status in older patients with diffuse large B-cell lymphoma (DLBCL). Ninety-five patients with DLBCL older than 70 years who were treated with immunochemotherapy were included. The lumbar L3 skeletal muscle index (L3-SMI) was measured by computed tomography at baseline, and sarcopenia was defined as low L3-SMI. Geriatric assessment included G8 score, CIRS-G scale, Timed Up and Go test, and instrumental activity of daily living. Nutritional status was assessed using the Mini Nutritional Assessment and the body mass index, and several scores used in the literature incorporating nutritional and inflammatory biomarkers, namely the Nutritional and inflammatory status (NIS), Geriatric Nutritional Risk Index, Prognostic Nutritional Index, and Glasgow Prognostic Score.Fifty-three patients were considered sarcopenic. Sarcopenic patients displayed higher levels of inflammation markers and lower levels of prealbumin than non-sarcopenic patients. Sarcopenia was associated with NIS, but was not associated with severe adverse events and treatment disruptions. They were, however, more frequent among patients with elevated NIS. Sarcopenia did not appear in this study as a prognostic factor for progression-free survival (PFS) or overall survival (OS). However, NIS emerged as predictive of the outcome with a 2-year PFS rate of 88% in the NIS ≤ 1 group and 49% in the NIS > 1 group and a significant effect in a multivariate analysis for both PFS (p = 0.049) and OS (HR = 9.61, CI 95% = [1.03–89.66], p = 0.04). Sarcopenia was not associated with adverse outcomes, but was related to NIS, which appeared to be an independent prognostic factor.

Validation and modification of simplified Geriatric Assessment and Elderly Prognostic Index: Effective tools for older patients with diffuse large B‐cell lymphoma

“…Previous studies have acknowledged the significance of CGA in DLBCL 14,15 . When assessing the objective health of older adults across multiple domains, including cognitive impairment, functional or physical impairment, and multimorbidity, geriatric assessment may affect cancer prognosis, treatment choices, and tolerance 16–21 . Notably, the G‐8 screening tool has demonstrated high sensitivity and acceptable specificity, and possess prognostic value in hematological malignancies 22,23 .…”

“… 14 , 15 When assessing the objective health of older adults across multiple domains, including cognitive impairment, functional or physical impairment, and multimorbidity, geriatric assessment may affect cancer prognosis, treatment choices, and tolerance. 16 , 17 , 18 , 19 , 20 , 21 Notably, the G‐8 screening tool has demonstrated high sensitivity and acceptable specificity, and possess prognostic value in hematological malignancies. 22 , 23 The Vulnerable Elders Survey‐13 is a stronger predictor of 1‐year mortality in older patients with DLBCL.…”

The Prognostic Role of Prognostic Nutritional Index and Controlling Nutritional Status in Predicting Survival in Older Adults with Oncological Disease: A Systematic Review

“…There was no consensus as to the definition of older individuals among the studies, with most including people above or equal to 75 years old (39%) or 65 years old (24%). The majority of the studies were retrospective cohort studies, with only two being prospective cohort studies [17,34]. Twenty-three studies (61%) were conducted in Japan, ten in China (26%), two in the Republic of Korea (5%), one in Australia, one in France, and one in Türkiye.…”

A Novel Inflammatory-Nutritional Prognostic Scoring System for Patients with Diffuse Large B Cell Lymphoma

“… 14–17 It is worth mentioning that patients with malnourishment are always accompanied by hyper-systemic inflammatory status. 18 The state of malnutrition may increase the severity of inflammation. The inflammatory response reduces albumin synthesis, in turn inducing malnutrition.…”