title: Impact of sarcopenia on treatment tolerance in United States veterans with diffuse large B-cell lymphoma treated with CHOP-based chemotherapy.
abstract: While sarcopenia has been associated with decreased overall survival in diffuse large B-cell (DLBCL) patients, the impact of sarcopenia on treatment tolerance has not been well-studied. We evaluated the association of sarcopenia with febrile neutropenia hospitalization, treatment-related mortality, and ability to complete standard number of cycles in a retrospective cohort of United States veterans diagnosed with DLBCL between 1998 and 2008 and treated with cyclophosphamide, doxorubicin, vincristine, and prednisone, with or without rituximab. Baseline body composition parameters were evaluated using computed tomography analysis. In total, 522 patients were included in the study, of whom 245 (47%) had baseline sarcopenia. After controlling for other variables, baseline sarcopenia was independently associated with increased risk of febrile neutropenia hospitalization (adjusted Odds Ratio (aOR) 1.64, 95% confidence interval (CI) 1.01-2.65) and inability to complete standard number of treatment cycles (aOR 1.49, 95% CI 1.02-2.16) compared with no baseline sarcopenia. There was a non-statistically significant trend toward higher treatment-related mortality in sarcopenic patients than non-sarcopenic patients (aOR 1.77, 95% CI 0.92-3.41). Sarcopenia is associated with increased risk of treatment intolerance and may be useful in guiding treatment planning and supportive care measures. Am. J. Hematol. 91:1002-1007, 2016. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, Missouri.|Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Daphne Y
authors.identifier: 0000-0001-7729-9360
authors.initials: DY
authors.lastname: Xiao
authors.affiliation: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, Missouri.|Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Suhong
authors.initials: S
authors.lastname: Luo
authors.affiliation: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, Missouri.|Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Katiuscia
authors.initials: K
authors.lastname: O'Brian
authors.affiliation: Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Arun
authors.initials: A
authors.lastname: Ganti
authors.affiliation: Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Peter
authors.initials: P
authors.lastname: Riedell
authors.affiliation: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, Missouri.|Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Sanfilippo
authors.affiliation: Division of Oncology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, California.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Lynch
authors.affiliation: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, Missouri.
authors.forename: Weijian
authors.initials: W
authors.lastname: Liu
authors.affiliation: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, Missouri. kcarson@dom.wustl.edu.|Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri. kcarson@dom.wustl.edu.|Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri. kcarson@dom.wustl.edu.
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Carson
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D006760:Hospitalization; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications / Q000188:drug therapy*; D008297:Male; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced; D011241:Prednisone / Q000008:administration & dosage; D055948:Sarcopenia / Q000401:mortality / Q000503:physiopathology*; D016896:Treatment Outcome; D014481:United States; D014728:Veterans; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone