Prognostic impact of sarcopenia in patients with diffuse large B-cell lymphoma treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone.
Sarcopenia is known to be related to an increased risk of chemotherapy toxicity and to a poor prognosis in patients with malignancy. We assessed the prognostic role of sarcopenia in patients with diffuse large B-cell lymphoma (DLBCL).



In total, 187 consecutive patients with DLBCL treated with induction rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) 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).



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. Thecindex 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).



Sarcopenia is associated with intolerance to standard R-CHOP chemotherapy as well as a poor prognosis. Moreover, sarcopenia itself can be included in prognostic models in DLBCL.
Division of Hematology-Oncology, Department of Internal Medicine Gyeongsang National University Hospital, Gyeongsang National University School of Medicine Gangnam-ro 79 Jinju Korea.
Se-Il
SI
Go
Department of Radiology Gyeongsang National University Hospital, Gyeongsang National University School of Medicine Gangnam-ro 79 Jinju Korea.
Mi Jung
MJ
Park
Division of Hematology-Oncology, Department of Internal Medicine Gyeongsang National University Hospital, Gyeongsang National University School of Medicine Gangnam-ro 79 Jinju Korea.
Haa-Na
HN
Song
Division of Hematology-Oncology, Department of Internal Medicine Gyeongsang National University Hospital, Gyeongsang National University School of Medicine Gangnam-ro 79 Jinju Korea; Gyeongsang Institute of Health Sciences Gangnam-ro 79 Jinju Korea.
Hoon-Gu
HG
Kim
Division of Hematology-Oncology, Department of Internal Medicine Gyeongsang National University Hospital, Gyeongsang National University School of Medicine Gangnam-ro 79 Jinju Korea.
Myoung Hee
MH
Kang
Division of Hematology-Oncology, Department of Internal Medicine Gyeongsang National University Hospital, Gyeongsang National University School of Medicine Gangnam-ro 79 Jinju Korea.
Hyang Rae
HR
Lee
Division of Hematology-Oncology, Department of Internal Medicine Gyeongsang National University Hospital, Gyeongsang National University School of Medicine Gangnam-ro 79 Jinju Korea.
Yire
Y
Kim
Department of Preventive Medicine and Environmental Health Center Gyeongsang National University Hospital, Gyeongsang National University School of Medicine Gangnam-ro 79 Jinju Korea.
Rock Bum
RB
Kim
Department of Internal Medicine Dankook University College of Medicine Cheonan Korea.
Soon Il
SI
Lee
Division of Hematology-Oncology, Department of Internal Medicine Gyeongsang National University Hospital, Gyeongsang National University School of Medicine Gangnam-ro 79 Jinju Korea; Gyeongsang Institute of Health Sciences Gangnam-ro 79 Jinju Korea.
Gyeong-Won
GW
Lee
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000473:pathology; D009367:Neoplasm Staging; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D000069283:Rituximab; D055948:Sarcopenia / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014750:Vincristine / Q000009:adverse effects / Q000627:therapeutic use; D055815:Young Adult
D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
Diffuse large B‐cell lymphoma; Nomogram; Prognosis; Sarcopenia; Toxicity