Sarcopenia and clinical evaluation in predicting treatment tolerability and outcomes in aggressive non-Hodgkin B cell lymphoma.

Abstract

e24018 Background: Sarcopenia is associated with decreased treatment tolerance and overall survival in aggressive large B-cell lymphoma, the most common non-Hodgkin lymphoma (NHL) in the geriatric population. The impact of sarcopenia on event-free survival (EFS) in older adults with an aggressive B-cell NHL remains unclear. Our primary endpoint was to evaluate the association between sarcopenia and 6-month EFS in adults aged 65 and older diagnosed with an aggressive B-cell NHL. Methods: We performed a retrospective cohort study of adults 65 years or older diagnosed with an aggressive B-cell NHL between July 1st 2014 and June 30th 2018 who completed 1st line chemotherapy in an academic center. Sarcopenia was defined as the lowest tertile of psoas muscle index (PMI). Psoas muscle area was measured on a single axial slice at L4 using CoreSlicer software, and divided by height squared. EFS defined as no death, relapse or hospitalisation, was compared between sarcopenic and non-sarcopenic individuals using Kaplan-Meier curves and multivariable Cox regression. Results: In our cohort of 62 older adults, median age was 74 (interquartile range (IQR): 69-78) and median PMI was 7.2 cm2/m2 (IQR: 5.9-8.4). Twenty patients were sarcopenic with a median PMI of 5.5 (4.8-6.3) cm2/m2. Most patients (56%) received full dose chemotherapy. Among patients who received an attenuated dose of chemotherapy, the percentage of patients with sarcopenia was similar to the one of patients receiving full dose chemotherapy (39% vs 24%, p=0.200). After controlling for age, sex, ECOG, cardiac disease, creatinine, LDH and hemoglobin levels, sarcopenia was associated with a lower EFS (HR 3.5, 95%CI: 1.1-11, p=0.032). Although sarcopenia was not associated with the choice of an attenuated chemotherapy intensity, when stratifying for chemotherapy intensity, there was a trend in favor of decreased EFS with sarcopenia in the full dose group (p=0.095), which did not reach statistical significance. Conclusions: Sarcopenia is associated with a lower 6-month EFS in older adults who completed first line chemotherapy. These individuals may benefit from pre-chemotherapy geriatric evaluation and tighter follow-up.