Clinical and prognostic role of sarcopenia in elderly patients with classical Hodgkin lymphoma: a multicentre experience

Journal of Cachexia, Sarcopenia and Muscle

Moana Manicone¹  Giuseppe Colloca²  Vittorio Ruggero Zilioli³  Cristina Muzi³  Doriana Gramegna⁴  Alessandra Tucci⁴  Francesco Merli⁵  Annalisa Arcari⁶  Domenico Albano⁷  Alessandra Coppola⁸  Manuela Camalori⁸  Giulia Besutti⁹  Patrizia Ciammella^1,10  Luigi Marcheselli^1,11 

[1] Clinical and Experimental PhD Program University of Modena and Reggio Emilia Modena Italy;Division of Geriatrics Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Rome Italy;Division of Hematology ASST Grande Ospedale Metropolitano Niguarda Milan Italy;Division of Hematology ASST Spedali Civili Brescia Italy;Division of Hematology Azienda USL—IRCCS di Reggio Emilia Reggio Emilia Italy;Division of Hematology Ospedale Guglielmo da Saliceto Piacenza Italy;Division of Nuclear Medicine ASST Spedali Civili Brescia Italy;Division of Radiology ASST Grande Ospedale Metropolitano Niguarda Milan Italy;Division of Radiology Azienda USL—IRCCS di Reggio Emilia Reggio Emilia Italy;Division of Radiotherapy Azienda USL—IRCCS di Reggio Emilia Reggio Emilia Italy;Fondazione Italiana Linfomi Onlus Trial Office Modena Modena Italy;

关键词: Hodgkin lymphoma;    Sarcopenia;    Geriatric assessment;    Elderly;   

DOI  :  10.1002/jcsm.12736

来源: DOAJ

【 摘 要 】

Abstract Background Elderly classical Hodgkin lymphoma (cHL) (ecHL) is a rare disease with dismal prognosis and no standard treatment. Fitness‐based approaches may help design appropriate treatments. Sarcopenia has been associated with an increased risk of treatment‐related toxicities and worse survival in various solid tumours, but its impact in ecHL is unknown. The aim of this retrospective multicentre study was to investigate the prognostic role of sarcopenia in ecHL. Methods We included newly diagnosed >64 years old cHL patients who performed a baseline comprehensive geriatric assessment and high‐dose computed tomography (CT) or 18fluorine‐fluorodeoxyglucose positron emission tomography/CT before any treatment. Sarcopenia was measured as skeletal muscle index (SMI, cm2/m2) by the analysis of high‐dose CT or low‐dose positron emission tomography/CT images at the L3 level. The specific cut‐offs for the SMI were determined by receiver operator curve analysis and compared with those proposed in literature and studied in diffuse large B‐cell lymphoma. Survival functions [progression‐free survival [PFS] and overall survival (OS)] were calculated for the whole population and for different subgroups defined as per different sarcopenia cut‐off levels. Results We included 154 patients (median age 71 years old, 76 female). The median L3‐SMI was 42 cm2/m2. The specific cut‐off derived in our male population was 45 cm2/m2; using this cut‐off, 27 male patients (35%) were defined as sarcopenic. After a median follow‐up of 5.9 years, the overall 5‐year PFS and OS rates were 53% and 65%, respectively, and were significantly shorter in sarcopenic male patients compared with non‐sarcopenic (PFS 31% vs. 61%, P = 0.008; OS 51% vs. 74%, P = 0.042). Applying diffuse large B‐cell lymphoma‐derived sarcopenic thresholds, there were no significant differences between sarcopenic and non‐sarcopenic patients for both PFS and OS, with a sole exception of a significant reduced PFS in sarcopenic male patients using Namakura cut‐off. The comprehensive geriatric assessment‐determined frail functional status was an independent adverse prognostic factor for both female and male patients. Conclusions Baseline evaluation of sarcopenia through radiological examinations performed for ecHL staging may help define a proportion of male patients with unfavourable outcome with current treatment strategies. Also the functional status evaluation could allow to identify a frail subgroup of patients with worse outcome.

【 授权许可】

Unknown