Prognostic impact of low muscle mass and low muscle density in patients with diffuse large B-cell lymphoma

Abstract

Low muscle mass (LMM) and low muscle density (LMD) are increasingly recognized as prognostic factors for survival in different malignancies. This study determined the association of LMM and LMD with survival in DLBCL (diffuse large B-cell lymphoma) patients. CT-based measurement of muscle was performed in 164 DLBCL patients prior to chemo-immunotherapy. Z-scores adjusted for gender, age, and body mass index were derived from a healthy reference population. LMM or LMD were defined as a Z-score below À1 and were related to OS and PFS. The coexistence of both LMM and LMD was observed in 13% of the DLBCL patients and was significantly associated with shorter OS and PFS. Also, these patients more often did not complete the planned treatment. The combination of LMM and LMD is an independent prognostic factor for survival in DLBCL patients. This may guide clinical decision-making in patients with suspected insufficient performance to benefit from chemo-immunotherapy in standard doses. KEY POINTS Patients with DLBCL have low muscle mass (LMM) and low muscle density (LMD) compared to healthy counterparts. The combination of LMM and LMD is a negative prognostic factor for survival, independent of comorbidities and unfavorable lymphoma characteristics.

RETRACTED: The impact of sarcopenia on prognosis of patients with pancreatic cancer: A systematic review and meta-analysis

“…[8][9][10] Studies in patients with different cancers demonstrated the association of sarcopenia with the increased risk of treatment-related adverse effects and complications as well as reduced survival. [11][12][13] Skeletal muscle is highly plastic and dynamic and accounts for around 40% of the total weight of the human body. 14 It is a massive reservoir of protein and contributes to around 50%-70% of the total human protein content.…”

Prognostic Value of Sarcopenia in Patients With Diffuse Large B-Cell Lymphoma Treated With R-CHOP: A Systematic Review and Meta-Analysis

“…However, this result was inconsistent with the previous studies. In the study by Rier, when low muscle mass (LMM) was used as the diagnostic criteria for sarcopenia, there was no difference in the rate of CR between the sarcopenia and non-sarcopenia groups (28). Another study showed that there was no difference in the rate of CR between the groups in patients whose chemotherapy treatment was uninterrupted (29).…”

“…In the two studies, skeletal muscle mass measured using SMI at the psoas level (CT-PM-SMI) (26) and fourth thoracic levels (CT-T4-SMI) (27) were used as the representative skeletal muscle mass of the whole body. One study used muscle mass at the L3 level on CT (CT-L3-muscle mass) as a diagnostic criterion for sarcopenia (28), while another study used a combination of CT-PM-SMI and CT-L3-SMI to diagnose sarcopenia (29). Eleven studies reported the OS and FPS.…”

High incidence of fractures after R-CHOP-like chemotherapy for aggressive B-cell non-Hodgkin lymphomas

“…Part of the mechanism by which R-CHOP-like chemotherapy results in fracture may be an acceleration of bone loss beyond what is expected with normal aging, which has been shown in other studies [14,15]. In addition, the disproportionately higher number of rib fractures after chemotherapy raises the possibility of increased fractures from falls, which patients may be at risk of if they develop sarcopenia or vincristinerelated peripheral neuropathy [27,28]. However, since we do not have information on skeletal muscle density, peripheral neuropathy, or falls, this possibility is speculative.…”