PROGNOSTIC SIGNIFICANCE OF SARCOPENIA IN PATIENTS WITH DIFFUSE LARGE B-CELL LYMPHOMA TREATED WITH RITUXIMAB PLUS CHOP (R-CHOP)
(Abstract release date: 05/19/16)
EHA Library. Lee G. 06/09/16; 134582; PB1682
Prof. Dr. Gyeong-Won Lee
Contributions
Contributions
Abstract
Abstract: PB1682
Type: Publication Only
Background
Sarcopenia, defined as the loss of skeletal muscle mass and strength, is one of the criteria for cancer cachexia. A computed tomography (CT) scan has been accepted as one of the most preferred tools to
assess sarcopenia. Measuring the extent of sarcopenia by CT in patients with malignancy has several
advantages, including accurate quantification of muscle mass, precise differentiation between fat and
muscle, and wide availability as a routine diagnostic tool in cancer. Sarcopenia evaluated by CT is
known to be related to an increased risk of chemotherapy toxicity, poorer functional status, and
reduced survival in malignancy.
Aims
In this study, we investigated the prognostic impact of sarcopenia in all age groups of patients with DLBCL using an extended cohort. Additionally, a new prognostic model, including sarcopenia and other significant prognostic factors, was constructed using a nomogram.
Methods
In total, 187 consecutive DLBCL patients treated with induction R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) immunochemotherapy were reviewed.
Sarcopenia was defined as the lowest sex-specific quartile of the skeletal muscle index, calculated by
dividing the pectoralis muscle area by the height. Clinical outcomes were compared between the
sarcopenic and non-sarcopenic groups. A nomogram was constructed from the Cox regression model for overall survival (OS).
Results
Treatment-related mortality (21.7% vs. 5.0%, p = 0.002) and early discontinuation of treatment
(32.6% vs. 14.9%, p = 0.008) were more common in the sarcopenic group than in the non-sarcopenic group. The 5-year progression-free survival (PFS) rates were 35.3% in the sarcopenic group and 65.8% in the non-sarcopenic group (p < 0.001). The 5-year OS rates were 37.3% in the sarcopenic group and 68.1% in the non-sarcopenic group (p < 0.001). Sarcopenia and the five variables of the International Prognostic Index (IPI) were independent prognostic factors in a multivariate analysis for PFS and OS, and were used to construct the nomogram. The calibration plot showed good agreement between the nomogram predictions and actual observations. The c index of the nomogram (0.80) was higher than those of other prognostic indices (IPI, 0.77, p = 0.009; revised-IPI, 0.74, p < 0.001; National Comprehensive Cancer Network-IPI, 0.77, p = 0.062).
Conclusion
This study demonstrates the role of sarcopenia as a poor prognostic marker in DLBCL patients. We suggest that dose adjustment and intensive supportive care should be considered in DLBCL patients with sarcopenia receiving induction R-CHOP immunochemotherapy. Further prospective studies
are warranted to confirm the prognostic role of sarcopenia and to externally validate the nomogram
including sarcopenia in DLBCL.
Session topic: E-poster
Keyword(s): Diffuse large B cell lymphoma, Muscle, Prognosis, Toxicity
Type: Publication Only
Background
Sarcopenia, defined as the loss of skeletal muscle mass and strength, is one of the criteria for cancer cachexia. A computed tomography (CT) scan has been accepted as one of the most preferred tools to
assess sarcopenia. Measuring the extent of sarcopenia by CT in patients with malignancy has several
advantages, including accurate quantification of muscle mass, precise differentiation between fat and
muscle, and wide availability as a routine diagnostic tool in cancer. Sarcopenia evaluated by CT is
known to be related to an increased risk of chemotherapy toxicity, poorer functional status, and
reduced survival in malignancy.
Aims
In this study, we investigated the prognostic impact of sarcopenia in all age groups of patients with DLBCL using an extended cohort. Additionally, a new prognostic model, including sarcopenia and other significant prognostic factors, was constructed using a nomogram.
Methods
In total, 187 consecutive DLBCL patients treated with induction R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) immunochemotherapy were reviewed.
Sarcopenia was defined as the lowest sex-specific quartile of the skeletal muscle index, calculated by
dividing the pectoralis muscle area by the height. Clinical outcomes were compared between the
sarcopenic and non-sarcopenic groups. A nomogram was constructed from the Cox regression model for overall survival (OS).
Results
Treatment-related mortality (21.7% vs. 5.0%, p = 0.002) and early discontinuation of treatment
(32.6% vs. 14.9%, p = 0.008) were more common in the sarcopenic group than in the non-sarcopenic group. The 5-year progression-free survival (PFS) rates were 35.3% in the sarcopenic group and 65.8% in the non-sarcopenic group (p < 0.001). The 5-year OS rates were 37.3% in the sarcopenic group and 68.1% in the non-sarcopenic group (p < 0.001). Sarcopenia and the five variables of the International Prognostic Index (IPI) were independent prognostic factors in a multivariate analysis for PFS and OS, and were used to construct the nomogram. The calibration plot showed good agreement between the nomogram predictions and actual observations. The c index of the nomogram (0.80) was higher than those of other prognostic indices (IPI, 0.77, p = 0.009; revised-IPI, 0.74, p < 0.001; National Comprehensive Cancer Network-IPI, 0.77, p = 0.062).
Conclusion
This study demonstrates the role of sarcopenia as a poor prognostic marker in DLBCL patients. We suggest that dose adjustment and intensive supportive care should be considered in DLBCL patients with sarcopenia receiving induction R-CHOP immunochemotherapy. Further prospective studies
are warranted to confirm the prognostic role of sarcopenia and to externally validate the nomogram
including sarcopenia in DLBCL.
Session topic: E-poster
Keyword(s): Diffuse large B cell lymphoma, Muscle, Prognosis, Toxicity
Abstract: PB1682
Type: Publication Only
Background
Sarcopenia, defined as the loss of skeletal muscle mass and strength, is one of the criteria for cancer cachexia. A computed tomography (CT) scan has been accepted as one of the most preferred tools to
assess sarcopenia. Measuring the extent of sarcopenia by CT in patients with malignancy has several
advantages, including accurate quantification of muscle mass, precise differentiation between fat and
muscle, and wide availability as a routine diagnostic tool in cancer. Sarcopenia evaluated by CT is
known to be related to an increased risk of chemotherapy toxicity, poorer functional status, and
reduced survival in malignancy.
Aims
In this study, we investigated the prognostic impact of sarcopenia in all age groups of patients with DLBCL using an extended cohort. Additionally, a new prognostic model, including sarcopenia and other significant prognostic factors, was constructed using a nomogram.
Methods
In total, 187 consecutive DLBCL patients treated with induction R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) immunochemotherapy were reviewed.
Sarcopenia was defined as the lowest sex-specific quartile of the skeletal muscle index, calculated by
dividing the pectoralis muscle area by the height. Clinical outcomes were compared between the
sarcopenic and non-sarcopenic groups. A nomogram was constructed from the Cox regression model for overall survival (OS).
Results
Treatment-related mortality (21.7% vs. 5.0%, p = 0.002) and early discontinuation of treatment
(32.6% vs. 14.9%, p = 0.008) were more common in the sarcopenic group than in the non-sarcopenic group. The 5-year progression-free survival (PFS) rates were 35.3% in the sarcopenic group and 65.8% in the non-sarcopenic group (p < 0.001). The 5-year OS rates were 37.3% in the sarcopenic group and 68.1% in the non-sarcopenic group (p < 0.001). Sarcopenia and the five variables of the International Prognostic Index (IPI) were independent prognostic factors in a multivariate analysis for PFS and OS, and were used to construct the nomogram. The calibration plot showed good agreement between the nomogram predictions and actual observations. The c index of the nomogram (0.80) was higher than those of other prognostic indices (IPI, 0.77, p = 0.009; revised-IPI, 0.74, p < 0.001; National Comprehensive Cancer Network-IPI, 0.77, p = 0.062).
Conclusion
This study demonstrates the role of sarcopenia as a poor prognostic marker in DLBCL patients. We suggest that dose adjustment and intensive supportive care should be considered in DLBCL patients with sarcopenia receiving induction R-CHOP immunochemotherapy. Further prospective studies
are warranted to confirm the prognostic role of sarcopenia and to externally validate the nomogram
including sarcopenia in DLBCL.
Session topic: E-poster
Keyword(s): Diffuse large B cell lymphoma, Muscle, Prognosis, Toxicity
Type: Publication Only
Background
Sarcopenia, defined as the loss of skeletal muscle mass and strength, is one of the criteria for cancer cachexia. A computed tomography (CT) scan has been accepted as one of the most preferred tools to
assess sarcopenia. Measuring the extent of sarcopenia by CT in patients with malignancy has several
advantages, including accurate quantification of muscle mass, precise differentiation between fat and
muscle, and wide availability as a routine diagnostic tool in cancer. Sarcopenia evaluated by CT is
known to be related to an increased risk of chemotherapy toxicity, poorer functional status, and
reduced survival in malignancy.
Aims
In this study, we investigated the prognostic impact of sarcopenia in all age groups of patients with DLBCL using an extended cohort. Additionally, a new prognostic model, including sarcopenia and other significant prognostic factors, was constructed using a nomogram.
Methods
In total, 187 consecutive DLBCL patients treated with induction R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) immunochemotherapy were reviewed.
Sarcopenia was defined as the lowest sex-specific quartile of the skeletal muscle index, calculated by
dividing the pectoralis muscle area by the height. Clinical outcomes were compared between the
sarcopenic and non-sarcopenic groups. A nomogram was constructed from the Cox regression model for overall survival (OS).
Results
Treatment-related mortality (21.7% vs. 5.0%, p = 0.002) and early discontinuation of treatment
(32.6% vs. 14.9%, p = 0.008) were more common in the sarcopenic group than in the non-sarcopenic group. The 5-year progression-free survival (PFS) rates were 35.3% in the sarcopenic group and 65.8% in the non-sarcopenic group (p < 0.001). The 5-year OS rates were 37.3% in the sarcopenic group and 68.1% in the non-sarcopenic group (p < 0.001). Sarcopenia and the five variables of the International Prognostic Index (IPI) were independent prognostic factors in a multivariate analysis for PFS and OS, and were used to construct the nomogram. The calibration plot showed good agreement between the nomogram predictions and actual observations. The c index of the nomogram (0.80) was higher than those of other prognostic indices (IPI, 0.77, p = 0.009; revised-IPI, 0.74, p < 0.001; National Comprehensive Cancer Network-IPI, 0.77, p = 0.062).
Conclusion
This study demonstrates the role of sarcopenia as a poor prognostic marker in DLBCL patients. We suggest that dose adjustment and intensive supportive care should be considered in DLBCL patients with sarcopenia receiving induction R-CHOP immunochemotherapy. Further prospective studies
are warranted to confirm the prognostic role of sarcopenia and to externally validate the nomogram
including sarcopenia in DLBCL.
Session topic: E-poster
Keyword(s): Diffuse large B cell lymphoma, Muscle, Prognosis, Toxicity
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