title: Longitudinal Body Composition Changes in Diffuse Large B-cell Lymphoma Survivors: A Retrospective Cohort Study of United States Veterans.
abstract: Body composition parameters are associated with long-term health outcomes. We assessed longitudinal body composition changes in diffuse large B-cell lymphoma (DLBCL) survivors and identified clinical variables associated with the long-term development of sarcopenia and visceral obesity.
  
  
  
  A retrospective cohort of United States veterans with DLBCL treated with cyclophosphamide, doxorubicin, vincristine, and prednisone, with or without rituximab, was assembled. Muscle, subcutaneous fat, and visceral fat areas were measured with computed tomography analysis. Data were analyzed with repeated-measures analysis of variance and logistic regression. All statistical tests were two-sided.
  
  
  
  Three hundred forty-two patients were included. Muscle area initially decreased during treatment, then returned to baseline by 24 months after treatment. Subcutaneous fat area increased from baseline by 6.5% (95% confidence interval [CI] = 2.6% to 10.5%) during treatment and by 21.4% (95% CI = 15.7% to 27.2%) by 24 months after treatment. Visceral fat area increased from baseline by 4.5% (95% CI = -0.9% to 9.9%) during treatment and by 21.6% (95% CI = 14.8% to 28.4%) by 24 months after treatment. Variables associated with long-term development of sarcopenia included: baseline sarcopenia (adjusted odds ratio [aOR] = 17.21, 95% CI = 8.48 to 34.94), older than age 60 years (aOR = 2.93, 95% CI = 1.46 to 5.88), and weight loss greater than 5% during treatment (aOR = 2.40, 95% CI = 1.12 to 5.14). Variables associated with long-term visceral fat gain included: weight gain greater than 5% during treatment (aOR = 4.60, 95% CI = 2.42 to 8.74).
  
  
  
  DLBCL survivors undergo unfavorable long-term body composition changes. Patients at risk for the long-term development of sarcopenia or visceral obesity can be identified based on clinical risk factors and targeted for lifestyle interventions.
authors.affiliation: Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (DYX, SL, KO, KMS, WL, KRC); Division of Public Health Sciences, Department of Surgery (KRC), and Division of Oncology, Department of Internal Medicine (SL, KO, KMS, PR, BSK, AFC, TAF, KRC), Washington University School of Medicine (DYX), St. Louis, MO; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI (AG); Division of Oncology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA (RCL).
authors.forename: Daphne Y
authors.initials: DY
authors.lastname: Xiao
authors.affiliation: Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (DYX, SL, KO, KMS, WL, KRC); Division of Public Health Sciences, Department of Surgery (KRC), and Division of Oncology, Department of Internal Medicine (SL, KO, KMS, PR, BSK, AFC, TAF, KRC), Washington University School of Medicine (DYX), St. Louis, MO; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI (AG); Division of Oncology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA (RCL).
authors.forename: Suhong
authors.initials: S
authors.lastname: Luo
authors.affiliation: Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (DYX, SL, KO, KMS, WL, KRC); Division of Public Health Sciences, Department of Surgery (KRC), and Division of Oncology, Department of Internal Medicine (SL, KO, KMS, PR, BSK, AFC, TAF, KRC), Washington University School of Medicine (DYX), St. Louis, MO; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI (AG); Division of Oncology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA (RCL).
authors.forename: Katiuscia
authors.initials: K
authors.lastname: O'Brian
authors.affiliation: Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (DYX, SL, KO, KMS, WL, KRC); Division of Public Health Sciences, Department of Surgery (KRC), and Division of Oncology, Department of Internal Medicine (SL, KO, KMS, PR, BSK, AFC, TAF, KRC), Washington University School of Medicine (DYX), St. Louis, MO; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI (AG); Division of Oncology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA (RCL).
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Sanfilippo
authors.affiliation: Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (DYX, SL, KO, KMS, WL, KRC); Division of Public Health Sciences, Department of Surgery (KRC), and Division of Oncology, Department of Internal Medicine (SL, KO, KMS, PR, BSK, AFC, TAF, KRC), Washington University School of Medicine (DYX), St. Louis, MO; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI (AG); Division of Oncology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA (RCL).
authors.forename: Arun
authors.initials: A
authors.lastname: Ganti
authors.affiliation: Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (DYX, SL, KO, KMS, WL, KRC); Division of Public Health Sciences, Department of Surgery (KRC), and Division of Oncology, Department of Internal Medicine (SL, KO, KMS, PR, BSK, AFC, TAF, KRC), Washington University School of Medicine (DYX), St. Louis, MO; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI (AG); Division of Oncology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA (RCL).
authors.forename: Peter
authors.initials: P
authors.lastname: Riedell
authors.affiliation: Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (DYX, SL, KO, KMS, WL, KRC); Division of Public Health Sciences, Department of Surgery (KRC), and Division of Oncology, Department of Internal Medicine (SL, KO, KMS, PR, BSK, AFC, TAF, KRC), Washington University School of Medicine (DYX), St. Louis, MO; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI (AG); Division of Oncology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA (RCL).
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Lynch
authors.affiliation: Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (DYX, SL, KO, KMS, WL, KRC); Division of Public Health Sciences, Department of Surgery (KRC), and Division of Oncology, Department of Internal Medicine (SL, KO, KMS, PR, BSK, AFC, TAF, KRC), Washington University School of Medicine (DYX), St. Louis, MO; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI (AG); Division of Oncology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA (RCL).
authors.forename: Weijian
authors.initials: W
authors.lastname: Liu
authors.affiliation: Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (DYX, SL, KO, KMS, WL, KRC); Division of Public Health Sciences, Department of Surgery (KRC), and Division of Oncology, Department of Internal Medicine (SL, KO, KMS, PR, BSK, AFC, TAF, KRC), Washington University School of Medicine (DYX), St. Louis, MO; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI (AG); Division of Oncology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA (RCL).
authors.forename: Brad S
authors.initials: BS
authors.lastname: Kahl
authors.affiliation: Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (DYX, SL, KO, KMS, WL, KRC); Division of Public Health Sciences, Department of Surgery (KRC), and Division of Oncology, Department of Internal Medicine (SL, KO, KMS, PR, BSK, AFC, TAF, KRC), Washington University School of Medicine (DYX), St. Louis, MO; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI (AG); Division of Oncology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA (RCL).
authors.forename: Amanda F
authors.initials: AF
authors.lastname: Cashen
authors.affiliation: Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (DYX, SL, KO, KMS, WL, KRC); Division of Public Health Sciences, Department of Surgery (KRC), and Division of Oncology, Department of Internal Medicine (SL, KO, KMS, PR, BSK, AFC, TAF, KRC), Washington University School of Medicine (DYX), St. Louis, MO; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI (AG); Division of Oncology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA (RCL).
authors.forename: Todd A
authors.initials: TA
authors.lastname: Fehniger
authors.affiliation: Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (DYX, SL, KO, KMS, WL, KRC); Division of Public Health Sciences, Department of Surgery (KRC), and Division of Oncology, Department of Internal Medicine (SL, KO, KMS, PR, BSK, AFC, TAF, KRC), Washington University School of Medicine (DYX), St. Louis, MO; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI (AG); Division of Oncology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA (RCL).
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Carson
mesh_terms: D050153:Abdominal Fat / Q000000981:diagnostic imaging; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001823:Body Composition; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging; D056128:Obesity, Abdominal / Q000000981:diagnostic imaging / Q000209:etiology*; D011241:Prednisone / Q000627:therapeutic use; D012189:Retrospective Studies; D000069283:Rituximab; D055948:Sarcopenia / Q000000981:diagnostic imaging / Q000209:etiology*; D050151:Subcutaneous Fat / Q000000981:diagnostic imaging; D017741:Survivors; D014057:Tomography, X-Ray Computed; D014481:United States; D014728:Veterans; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone