Therapeutics and Clinical Risk Management (Sep 2021)
More Pronounced Muscle Loss During Immunochemotherapy is Associated with Worse Clinical Outcomes in Newly Diagnosed Patients with Diffuse Large B-Cell Lymphoma with Unfavorable Features
Abstract
Marko Lucijanic,1,2 Renata Huzjan Korunic,2,3 Martina Sedinic,1 Rajko Kusec,1,2 Vlatko Pejsa1,2 1Hematology Department, University Hospital Dubrava, Zagreb, Croatia; 2University of Zagreb School of Medicine, Zagreb, Croatia; 3Radiology Department, University Hospital Dubrava, Zagreb, CroatiaCorrespondence: Marko LucijanicHematology Department, University Hospital Dubrava, Av. Gojka Suska 6, Zagreb, 10000, CroatiaEmail [email protected]: Cancer-induced cachexia is associated with poor prognosis in patients with non-Hodgkin lymphoma, but it is unknown how and to what extent curable lymphoma treatments affect the musculoskeletal system.Patients and Methods: We retrospectively analyzed 104 newly diagnosed diffuse large B-cell lymphoma (DLBCL) patients with unfavorable disease features treated with the R-DA-EPOCH regimen. Psoas muscle area (PMA) measured at L3 vertebra level was compared between staging (pre-therapy) and revision (end of treatment) computerized tomography (CT) scans.Results: Small but significant decline in PMA was observed during the immunochemotherapy period (average loss 5%; P=0.016) with 57.7% of patients experiencing muscle loss. Higher body surface area (OR=17.98 for each m2; P=0.034), number of cycles with dose reduction (OR=2.86 for each cycle; P=0.039) and worse response to therapy (OR=3.09 for each response category; P=0.052) were recognized as independent contributors to the PMA loss in multivariate analysis. One quarter of patients had more pronounced PMA loss (≥ 21%), which was associated with significantly worse overall and progression-free survival. Both ≥ 21% PMA loss and non-achieving response to therapy remained independently associated with inferior OS (PMA loss HR=2.98; P=0.016 and achieving response HR=0.04; P< 0.001) and PFS (PMA loss HR=3.16; P=0.005 and achieving response HR=0.08; P=0.001) in multivariate analyses.Discussion: Muscle loss occurs in approximately half of newly diagnosed DLBCL patients with unfavorable disease features during R-DA-EPOCH immunochemotherapy. If pronounced, this is associated with worse clinical outcomes irrespectively of achieved response to therapy. Muscle loss seems to be mostly affected by the efficacy and tolerability of the regimen.Keywords: diffuse large B-cell lymphoma, sarcopenia, psoas muscle, R-DA-EPOCH, survival
