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 need for novel predictors. Analysis of body composition and muscle mass can provide an objective assessment to identify vulnerable populations, as sarcopenia and frailty have been reported to predict outcomes in other tumor types. In this retrospective cohort study of patients undergoing ASCT for lymphoma, we investigated associations of sarcopenia with clinically significant outcomes, including overall survival (OS) and progression-free survival (PFS). Computed tomography (CT) images of 78 patients obtained routinely pretransplantation were used to assess skeletal muscle mass and are reported as skeletal muscle index (SMI). OS, PFS, and clinical outcomes of interest were compared between groups. Twenty-seven patients (34.6%) in the cohort met the criteria for sarcopenia. Patients with sarcopenia had a significantly shorter 3-year PFS (59% [95% confidence interval (CI), 38% to 75%] versus 84% [95% CI, 71% to 92%]; P =.02) after 3 years of follow up, whereas there was no difference in OS between patients with and those without sarcopenia (78% [95% CI, 57% to 89%] versus 88% [95% CI, 76% to 95%]; P =.25). Interestingly, no difference in survival was found with stratification based on the Karnofsky Performance Scale or Hematopoietic Cell Transplantation-Specific Comorbidity Index. There also were no significant between-group differences 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. This is the first study to our knowledge to correlate sarcopenia with disease control and PFS after ASCT in lymphoma. Possible explanations include a 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.
Bibliographical noteFunding Information:
Financial disclosure: The research reported in this article was supported by National Institutes of Health Grant P30 CA77598 utilizing the Biostatistics Core.
Financial disclosure: The research reported in this article was supported by National Institutes of Health Grant P30 CA77598 utilizing the Biostatistics Core. Conflict of interest statement: J.E.M.’s institution receives research funding on his behalf from CRISPR Therapeutics, Talaris, Scripps, ADC Therapeutics, Gilead, Precision Biosciences, and Fate Therapeutics. B.C.B. holds a provisional patent (WO2019165156; “CD83-binding chimeric antigen receptors”) related to the use of CD83 chimeric antigen receptor T cell therapy in graft-versus-host disease prevention and treatment. The intellectual property is licensed to an industry collaborator, with revenue received by the inventor, the University of Minnesota, and Moffitt Cancer Center. Financial disclosure: See Acknowledgments on page XXX.
© 2023 The American Society for Transplantation and Cellular Therapy
- Allogeneic hematopoietic stem cell transplantation
- Autologous hematopoietic stem cell transplantation
- Hematopoietic stem cell transplantation
- Hodgkin lymphoma
- Muscle mass
- Non-Hodgkin lymphoma
PubMed: MeSH publication types
- Journal Article
- Research Support, N.I.H., Extramural