Skeletal Muscle Radio-Density Is an Independent Predictor of Response and Outcomes in Follicular Lymphoma Treated with Chemoimmunotherapy

Abstract

Skeletal muscle radio-density (SMD) measures muscle radiation attenuation (in Hounsfield Units, HU) on computed tomography (CT) scans. Low SMD is prognostic of poor survival in melanoma, however its significance is unknown for hematologic malignancies. We performed a single institution, retrospective review of all follicular lymphoma (FL) patients who received chemoimmunotherapy from 2004–2009. Patient demographics, FL International Prognostic Index 1 (FLIPI-1), progression free (PFS) and overall survival (OS) were collected as primary endpoints. Objective response rates (ORR) were secondary. SMD was calculated using pre-treatment CT scans. In 145 patients reviewed, median values were age 59, FLIPI-1 of 2, stage III, and 8 chemoimmunotherapy cycles received. Median PFS for those with low SMD (<36.6 and <33.1 HU for patients with BMI ≤ 25 and > 25 kg/m2, respectively) compared to those with high SMD was profoundly worse, 69.6 vs. 106.7 months (hazard ratio [HR] 1.85; p = 0.01), respectively. Median OS was not reached in patients with high SMD vs. 92.7 months in low SMD patients (HR 4.02; p = 0.0002). Multivariate analysis supported lower SMD’s OS detriment (HR = 3.40; p = 0.002) independent of FLIPI-1 (HR 1.46–2.76, p = 0.05) or gender. Low SMD predicted lower ORR, 83 vs. 96% (p = 0.01). SMD predicts survival independent of FLIPI-1 and potentially chemoimmunotherapy response. SMD is an inexpensive and powerful tool that can complement FLIPI-1.

Low skeletal muscle radiation attenuation and visceral adiposity are associated with overall survival and surgical site infections in patients with pancreatic cancer

“…To our knowledge, no studies have been reported that use similar methodology to investigate muscle radiation attenuation in patients with pancreatic cancer. When looking at studies in other malignancies with similar methodology as the present study, low muscle radiation attenuation has consistently been associated with poor survival in hepatocellular carcinoma, respiratory and colorectal cancer, and follicular lymphoma . Skeletal muscle area was not associated with outcomes in the present study, which agrees with previous findings in pancreatic cancer patients .…”

Skeletal muscle density is an independent predictor of diffuse large B‐cell lymphoma outcomes treated with rituximab‐based chemoimmunotherapy

“…In this study, low SMD appeared to be more prognostic of poor patient survival than skeletal muscle index. Low SMD is also similarly more prognostic than skeletal muscle index in melanoma, renal cell cancer, and follicular lymphoma . It is important to note that cut‐point analysis in our study independently established the same SMD parameters defined in solid organ malignancies—providing early validation of its continued use of these cut points in DLBCL .…”

“…Clinically, sarcopenia and cachexia are related in cancer patients, both of which have been shown to be poor prognostic indicators . Low SMD, though, appears to be more prognostic than sarcopenia in both solid and haematologic cancers . It was previously observed that SMD was prognostic of survival in follicular lymphoma, an indolent form of non‐Hodgkin lymphoma.…”

Low Skeletal Muscle Density Is Associated with Early Death in Patients with Perihilar Cholangiocarcinoma Regardless of Subsequent Treatment

“…In other tumours, such as follicular lymphoma, melanoma, and metastatic renal cell and gastric carcinoma, no association between skeletal muscle mass and survival was shown, whereas skeletal muscle density was an independent prognostic factor [28, 30-33]. The similarity between these studies and the current study is the aggressive course of the disease, which may have led to the inability to accurately predict outcome.…”