Combination of Sarcopenia and Anemia Predicts Worse Outcome in Elderly Patients With Diffuse Large B-Cell Lymphoma

Abstract

Background/Aim: In diffuse large B-cell lymphoma (DLBCL), sarcopenia is associated with increased side-effects of chemotherapy and poor survival, especially in elderly patients. Anemia, a complex condition resulting from cancer itself and inflammation, might have a correlation with loss of muscle mass and might also indicate a worse outcome. In this study, we aimed to investigate the association of the skeletal muscle index (SMI) at the third lumbar vertebra (L3) with hemoglobin (Hb) levels and its predictive value for the outcome of DLBCL. Patients and Methods: The study included patients, aged 70 or older, newly diagnosed with DLBCL who received immunochemotherapy. Sex-specific L3-SMI was measured by computed tomography, and Hb levels before treatment were recorded. The Kaplan-Meier method and Cox regression model were used to analyze survival and prognostic factors. Results: Anemia was correlated with a low SMI. The presence of either low L3-SMI or anemia (Hb <10.5 g/l) indicated a poor prognosis for both progression-free and overall survival. A novel score combining L3-SMI, and Hb and lactate dehydrogenase levels as independent predictive factors was proposed for treatment response, progressionfree and overall survival after adjusting for International Prognostic Index. Conclusion: This study highlights the importance of sarcopenia and anemia in patients with DLBCL, particularly in the elderly population. The proposed novel score combining L3-SMI, Hb, and lactate dehydrogenase may provide additional prognostic information for patients with DLBCL, aiding in treatment decisions and management.Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL), and its incidence is strongly related to increasing age. A significant proportion of patients with DLBCL, about 25-35%, are over 70 years old (1, 2). Sarcopenia is a condition that is identified by a gradual reduction in both skeletal muscle mass and strength (3-5). The prevalence of sarcopenia ranges from 15% to 50% in elderly patients with cancer. It may increase the risk of infection and lead to longer hospitalization and higher mortality (6, 7). It is emerging that sarcopenia is a risk factor for treatment toxicity and poorer overall and progression-free survival (8). Decreased muscle mass is one of the most important criteria when defining sarcopenia. There is a growing body of evidence to 1847