Abstract

Autologous hematopoietic stem cell transplantation (ASCT) improves survival for patients with chemotherapy-sensitive lymphoma. Validated scoring systems are used in the clinical setting to predict treatment toxicity and survival. However, complications related to disease and treatment still occur, highlighting challenges in optimal patient selection and the necessity of novel predictors. Analysis of body composition and muscle mass can offer an objective assessment to identify vulnerable populations as sarcopenia and frailty have been reported to predict outcomes in other tumor types. This is a retrospective cohort study investigating associations of sarcopenia in patients undergoing ASCT for lymphoma with clinically significant outcomes including overall survival (OS) and progression-free survival (PFS). Computed tomography (CT) images obtained routinely pretransplant of 78 patients were used to assess skeletal muscle mass and reported as skeletal muscle index (SMI). OS, PFS, and clinical outcomes of interest were reported and compared between groups. There were 27 patients (34.6%) in the cohort who met the criteria of sarcopenia. Patients with sarcopenia had a significantly shorter 3-year PFS [59% (95% CI 38% - 75%) versus 84% (95% CI 71% - 92%); p = 0.02] after 3 years of follow up while there was no difference in OS [78% (95% CI 57% - 89%) versus 88% (95% CI 76% - 95%); p = 0.25]. Interestingly, no difference in survival was found with stratification based on Karnofsky performance scale (KPS) or hematopoietic cell transplantation-specific comorbidity index (HCT-CI). There was no significant difference in length of hospital stay and the incidences of other clinical outcomes of interest including febrile neutropenia, mucositis, total parenteral nutrition requirement, acute kidney injury, rate of readmission, or intensive care unit admission observed in our study. This is the first study to our knowledge to correlate sarcopenia with disease control and PFS after ASCT in lymphoma. Possible explanations include higher rate of chemotherapy-related toxicity leading to disruptions of treatment as well as dysfunction of antitumor immunity secondary to impaired regulations from myokines from the loss of muscle mass or an unknown cause that is yet to be elucidated. Physical therapy programs and personalized regimens for treatment based on the analysis of body composition indices can be further studied and implemented to mitigate treatment-related toxicity and to optimize survival in patients with sarcopenia.

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