title: Prognostic impact of fat tissue loss and cachexia assessed by computed tomography scan in elderly patients with diffuse large B-cell lymphoma treated with immunochemotherapy.
abstract: OBJECTIVE
  Approximately 30% of DLBCL patients are older than 70 yr. This study evaluated the prognostic impact of a cachexia score (CS) including fat tissue loss (adipopenia) and sarcopenia as assessed by computed tomography (CT scan) in elderly DLBCL patients treated with chemotherapy and rituximab (R).
  
  
  METHODS
  This retrospective analysis included 80 DLBCL patients older than 70 yr treated with R-CHOP or R-miniCHOP. Skeletal muscle (SM) and visceral (V) and subcutaneous (S) adipose (A) tissues were measured by analysing CT images at the third lumbar (L3) level.
  
  
  RESULTS
  The median age of the patients was 78 yr. Forty-four and 46 patients were considered sarcopenic and adipopenic, respectively. The median progression-free survival (PFS) was 13.6 months in the adipopenic group and 49.4 months in the non-adipopenic group [hazard ratio (HR) = 2.27; 95% confidence interval (CI): 1.3-4; P = 0.0042]. The median overall survival (OS) was 25.7 months in the adipopenic group and 57.1 months in the non-adipopenic group (HR = 1.93; 95% CI: 1.05-3.55; P = 0.0342). A two-point CS including adipopenia and sarcopenia was created and defined two distinct risk groups with differences in outcomes that were highly significant. The CS was predictive of the prognosis in a multivariate analysis including body mass index (BMI) (< or ≥ 25 kg/m(2) ), age (< or ≥ 80 yr), international prognostic index (IPI) and albuminaemia (HR = 3.67; 95% CI = 1.93-6.97; P < 0.0001).
  
  
  CONCLUSIONS
  A CS including sarcopenia and adipopenia, assessed by a single CT scan slice, predicts outcome independent of BMI and the IPI.
authors: Department of Haematology, Centre Henri Becquerel, Rouen, France; Centre Henri Becquerel, INSERM U918, IRIB, Rouen, France.
authors: Vincent
authors: V
authors: Camus
authors: Helene
authors: H
authors: Lanic
authors: Jerôme
authors: J
authors: Kraut
authors: Romain
authors: R
authors: Modzelewski
authors: Florian
authors: F
authors: Clatot
authors: Jean M
authors: JM
authors: Picquenot
authors: Nathalie
authors: N
authors: Contentin
authors: Pascal
authors: P
authors: Lenain
authors: Luminata
authors: L
authors: Groza
authors: Emilie
authors: E
authors: Lemasle
authors: Carole
authors: C
authors: Fronville
authors: Nathalie
authors: N
authors: Cardinael
authors: Marie-Laure
authors: ML
authors: Fontoura
authors: Ali
authors: A
authors: Chamseddine
authors: Oana
authors: O
authors: Brehar
authors: Aspasia
authors: A
authors: Stamatoullas
authors: Stéphane
authors: S
authors: Leprêtre
authors: Hervé
authors: H
authors: Tilly
authors: Fabrice
authors: F
authors: Jardin
mesh_terms: D000273:Adipose Tissue / Q000473:pathology*; D000368:Aged; D000369:Aged, 80 and over; D002100:Cachexia / Q000150:complications*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007167:Immunotherapy; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: adipopenia; cachexia; diffuse large B cell lymphoma; elderly; fat tissue loss; prognosis