Abstract
Baseline CT scans of 116 patients (48% female, median 64 years) with diffuse large B-cell lymphoma (DLBCL) were retrospectively reviewed to investigate the prognostic role of sarcopenia and fat compartment distributions on overall survival (OS), progression-free survival (PFS), and early therapy termination. Skeletal muscle index (SMI), skeletal muscle density (SMD), and intermuscular adipose tissue (IMAT) were quantified at the level of the third lumbar vertebra (L3) and proximal thigh (PT). Low L3-SMD, but not low L3-SMI, was associated with early therapy termination (p = 0.028), shorter OS (HR = 6.29; 95% CI = 2.17–18.26; p < 0.001), and shorter PFS (HR = 2.42; 95% CI = 1.26–4.65; p = 0.008). After correction for sex, International Prognostic Index (IPI), BMI, and R-CHOP therapy (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), low L3-SMD remained associated with poor OS (HR = 3.54; 95% CI = 1.10–11.40; p = 0.034) but not with PFS. Increased PT-IMAT was prognostic for poor OS and PFS after correction for sex, IPI, BMI, and R-CHOP therapy (HR = 1.35; CI = 1.03–1.7; p = 0.03, and HR = 1.30; CI = 1.04–1.64; p = 0.024, respectively). Reduced muscle quality (SMD) and increased intermuscular fat (IMAT), rather than low muscle quantity (SMI), are associated with poor prognosis in DLBCL, when measured at the L3 level, and particularly at the level of the proximal thigh. The proximal thigh represents a novel radiological landmark to study body composition.
Highlights
IntroductionAmong the various histological subtypes, diffuse large B-cell lymphoma (DLBCL) accounts for 25–35% of all cases [2]
Non-Hodgkin lymphoma is the fifth most common neoplasia in Western countries [1]
Of 120 patients diagnosed with diffuse large B-cell lymphoma (DLBCL) between January 2014 and December 2017 at our institution, 4 were excluded because of unavailability of PET-CT examination performed at baseline for staging purposes, leaving a total of 116 patients included in the study
Summary
Among the various histological subtypes, DLBCL accounts for 25–35% of all cases [2]. With the advent of modern chemoimmunotherapy regimens, more than 50% of DLBCL patients achieve complete remission [3]. Many patients still fail to achieve an optimal response or experience relapse, and the most used prognostic tools to identify these subjects comprise only few clinical features (age, stage, performance status, serum lactate dehydrogenase level, number of involved extranodal sites) that were validated more than 20 years ago [4]. Body composition parameters are associated with long-term health outcomes in many diseases and have been recently studied as prognostic factors in DLBCL patients. Researchers have reported a negative impact of sarcopenia on survival outcomes in DLBCL patients treated with the R-CHOP regimen [5,6,7], among elderly patients [5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
