Muscle Loss During Immunochemotherapy For Diffuse Large B-Cell Lymphoma And Its Clinical And Prognostic Associations

Context Cancer induced cachexia is associated with poor prognosis in patients with diffuse large B-cell lymphoma (DLBCL) but it is unknown how and to what extent curable lymphoma treatments affect musculoskeletal system. Objective To investigate how immunochemotherapy affects muscle mass and whether this has prognostic consequences in newly diagnosed DLBCL patients. Design Retrospective cohort study including period from 2005-2019. Setting Tertiary hematologic center. Patients or Other Participants 104 newly diagnosed adult DLBCL patients with unfavorable features (proliferative index Ki67+ ≥80% and/or International Prognostic Index (IPI) ≥2 points) treated with the R-DA-EPOCH regimen with available baseline and end of treatment CT scans. Methods Psoas muscle area (PMA) at L3 vertebra level was compared between revision and baseline CT scans. Main Outcomes Measures PMA change during immunochemotherapy, overall survival (OS), progression free survival (PFS). Results Small but significant decline in PMA was observed during immunochemotherapy period (average loss 5%; P=0.016) with 57.7% patients experiencing muscle loss. In the multivariate logistic regression analysis higher body surface area (OR 17.98 for each m2; P=0.034), higher number of cycles with dose reduction (OR 2.86 for each cycle; P=0.039) and weaker response to therapy (OR 3.09 for each response category; P=0.052) were recognized as independent contributors to the PMA loss. Age, sex, baseline psoas muscle index, body mass index, Ki-67, Ann Arbor and R-IPI staging systems had no significant association with the extent of PMA loss. A total of 25/104 (24%) of patients experienced ≥21% PMA loss (ROC curve analysis defined optimal cut-off level) which was associated with significantly worse overall (OS; HR=8.58; P Conclusions Muscle loss occurs in approximately half newly diagnosed DLBCL patients with unfavorable disease features during R-DA-EPOCH immunochemotherapy, and if pronounced, this is associated with worse clinical outcomes irrespectively of achieved response to therapy. The most relevant predictors of muscle loss during chemotherapy period seem to be immunochemotherapy related, i.e., associated with the dose, toleration and efficacy of immunochemotherapy.