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

Xu, Xi; He, Dan; Tian, Meng-Xing; Wu, Hongyan; Jin, Xin

doi:10.3389/fnut.2022.816883

Cited by 17 publications

(9 citation statements)

References 45 publications

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“…The present study showed that the incidence of sarcopenia was 29.1% at baseline and 36.9% at the end-of-treatment, which is in accordance with prior studies reporting a sarcopenia incidence of 23.9%–55.6% in DLBCL patients [ 18 ]. Although there was no significant difference in BMI before and after treatment, SMI was found to significantly decrease at end-of-treatment compared with baseline.…”

Section: Discussionsupporting

confidence: 93%

“…It is defined as a gradual decrease in both the mass and/or strength of the skeletal muscle. At present, the diagnosis of sarcopenia mainly relies on the measurement of SMA at the L3 level using a single-slice CT image which needs to be subsequently normalized as SMI [ 18 ]. The whole-body PET/CT scan is a routine examination for diagnosing, staging, and evaluating treatment response in malignancies, including DLBCL.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, several studies have reported that sarcopenia is a poor prognostic factor in treatment-naïve patients with DLBCL [ 18 20 25 ]. For instance, Lucijanic et al [ 20 ] found that muscle loss was significantly associated with worse clinical outcomes in patients newly diagnosed with DLBCL.…”

Section: Discussionmentioning

confidence: 99%

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Implications of Sarcopenia and Glucometabolism Parameters of Muscle Derived From Baseline and End-of-Treatment ¹⁸F-FDG PET/CT in Diffuse Large B-Cell Lymphoma

Tan,

Sun,

Chen

et al. 2024

Korean J Radiol

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Objective We previously found that the incidence of sarcopenia increased with declining glucose metabolism of muscle in patients with treatment-naïve diffuse large B-cell lymphoma (DLBCL). This study aimed to investigate the relationship between sarcopenia and muscle glucometabolism using 18 F-FDG PET/CT at baseline and end-of-treatment, analyze the changes in these parameters through treatment, and assess their prognostic values. Materials and Methods The records of 103 patients with DLBCL (median 54 years [range, 21–76]; male:female, 50:53) were retrospectively reviewed. Skeletal muscle area at the third lumbar vertebral (L3) level was measured, and skeletal muscle index (SMI) was calculated to determine sarcopenia, defined as SMI < 44.77 cm 2 /m 2 and < 32.50 cm 2 /m 2 for male and female, respectively. Glucometabolic parameters of the psoas major muscle, including maximum standardized uptake value (SUVmax) and mean standardized uptake value (SUVmean), were measured at L3 as well. Their changes across treatment were also calculated as ∆SMI, ∆SUVmax, and ∆SUVmean; ∆body mass index was also calculated. Associations between SMI and the metabolic parameters were analyzed, and their associations with progression-free survival (PFS) and overall survival (OS) were identified. Results The incidence of sarcopenia was 29.1% and 36.9% before and after treatment, respectively. SMI ( P = 0.004) was lower, and sarcopenia was more frequent ( P = 0.011) at end-of-treatment than at baseline. The SUVmax and SUVmean of muscle were lower ( P < 0.001) in sarcopenia than in non-sarcopenia at both baseline and end-of-treatment. ∆SMI was positively correlated with ∆SUVmax of muscle ( P = 0.022). Multivariable Cox regression analysis showed that sarcopenia at end-of-treatment was independently negatively associated with PFS (adjusted hazard ratio [95% confidence interval], 2.469 [1.022–5.965]), while sarcopenia at baseline was independently negatively associated with OS (5.051 [1.453–17.562]). Conclusion Sarcopenic patients had lower muscle glucometabolism, and the muscular and metabolic changes across treatment were positively correlated. Sarcopenia at baseline and end-of-treatment was negatively associated with the prognosis of DLBCL.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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Implications of Sarcopenia and Glucometabolism Parameters of Muscle Derived From Baseline and End-of-Treatment ¹⁸F-FDG PET/CT in Diffuse Large B-Cell Lymphoma

Tan,

Sun,

Chen

et al. 2024

Korean J Radiol

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“…Sarcopenia, defined by the depletion of skeletal muscle, has been recognized as an unfavorable prognostic factor and predictor of chemotherapy toxicity in older patients with solid tumors [27][28][29][30]. In patients with DLBCL, several studies showed that sarcopenic patients had poor outcomes in terms of survival and progression-free survival (PFS) [31][32][33][34][35] as well as treatment-related mortality and treatment discontinuation [33,36,37]. However, other studies did not retain sarcopenia as an independent prognostic factor [38][39][40][41][42].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2023

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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.

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“…The presence of a R-IPI poor risk score and a higher NLR, the R-COP regimen, and infections were predictors of shorter PFS and OS. Upon reviewing the literature, conflicting results were found, and the predictive value of sarcopenia in patients with poor survival was not confirmed for hematological malignancies (11,(36)(37)(38)(39)(40). This difference could be directly associated with the heterogeneity of samples studied, such as lymphoma variants, type of treatment, stage, SMI thresholds, and imaging tools.…”

Section: Discussionmentioning

confidence: 99%

Association Between the Neutrophil-to-Lymphocyte Ratio and Infection and Survival in Diffuse Large B Cell Lymphoma

Shih

Lue

Wang

et al. 2023

In Vivo

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Background/Aim: Infection is a common cause of morbidity and mortality in patients treated for diffuse large Bcell lymphoma (DLBCL). However, there is limited information on the impact and risk factors for infection among patients receiving rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisolone (R-CHOP). Patients and Methods: A retrospective study evaluating patients with DLBCL receiving R-CHOP and R-COP between 2004 and 2021 was conducted at a medical center. Hospital patients' records for the five-item modified frailty index (mFI-5), sarcopenia, blood-based inflammatory markers, and clinical outcomes were statistically analyzed. Results: Patients with frailty, sarcopenia, and high neutrophil-to-lymphocyte ratio (NLR) were associated with a higher risk of infections. The revised International Prognostic Index poor-risk group, high NLR, infections, and treatment modality were risk factors for shorter progression-free and overall survival. Conclusion: Pre-treatment high NLR was a predictor of infection and survival outcome in DLBCL patients.Diffuse large B cell lymphoma (DLBCL) is the most common type of lymphoma (1). Chemoimmunotherapy (CIT) with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP), the standard of care for DLBCL, is effective in 60%-70% of patients (2, 3).Bone marrow suppression induced febrile neutropenia (FN), and infections were crucial in the pathogenesis of lymphoma treatment-related mortality (4). During treatment with the R-CHOP regimen in DLBCL, up to 24% (5) and 63% (6) of patients present with FN and infection, respectively. Advanced disease, older age, poor performance status, comorbidities, poor nutritional status, and the absence of granulocyte colonystimulating factor (G-CSF) prophylaxis were independent risk factors for FN in patients treated with the R-CHOP regimen (7-9).Infection is a typical cause of morbidity and mortality in patients treated for lymphoma. However, there is limited information on infection risk factors and their impact on patients treated for DLBCL. Extensive research has previously revealed that sarcopenia, frailty status, and bloodbased biomarkers including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and systemic immune-inflammation index (SII) are significant prognostic markers of DLBCL (10-12). Up to now, there has been no comprehensive analysis of the associated infection and survival outcome in patients with DLBCL.Thus, the current study aimed to retrospectively analyze the predictive effect of frailty, sarcopenia, and blood-based inflammatory markers on infections and survival outcomes in patients with DLBCL treated with the R-CHOP or R-COP regimen. Patients and MethodsPatient selection criteria. This retrospective study was approved by the Research Ethics Committee of the Hualien Tzu Chi General 948

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

Cited by 17 publications

References 45 publications

Implications of Sarcopenia and Glucometabolism Parameters of Muscle Derived From Baseline and End-of-Treatment ¹⁸F-FDG PET/CT in Diffuse Large B-Cell Lymphoma

Implications of Sarcopenia and Glucometabolism Parameters of Muscle Derived From Baseline and End-of-Treatment ¹⁸F-FDG PET/CT in Diffuse Large B-Cell Lymphoma

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

Association Between the Neutrophil-to-Lymphocyte Ratio and Infection and Survival in Diffuse Large B Cell Lymphoma

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

Cited by 17 publications

References 45 publications

Implications of Sarcopenia and Glucometabolism Parameters of Muscle Derived From Baseline and End-of-Treatment 18F-FDG PET/CT in Diffuse Large B-Cell Lymphoma

Implications of Sarcopenia and Glucometabolism Parameters of Muscle Derived From Baseline and End-of-Treatment 18F-FDG PET/CT in Diffuse Large B-Cell Lymphoma

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

Association Between the Neutrophil-to-Lymphocyte Ratio and Infection and Survival in Diffuse Large B Cell Lymphoma

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Implications of Sarcopenia and Glucometabolism Parameters of Muscle Derived From Baseline and End-of-Treatment ¹⁸F-FDG PET/CT in Diffuse Large B-Cell Lymphoma

Implications of Sarcopenia and Glucometabolism Parameters of Muscle Derived From Baseline and End-of-Treatment ¹⁸F-FDG PET/CT in Diffuse Large B-Cell Lymphoma