Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar 23;28(2):1325-1337.
doi: 10.3390/curroncol28020126.

Body Composition as a Predictor of Toxicity and Prognosis in Patients with Diffuse Large B-Cell Lymphoma Receiving R-CHOP Immunochemotherapy

Jiaxun Guo  1 , Panpan Cai  1 , Pengfei Li  2 , Cong Cao  1 , Jing Zhou  1 , Lina Dong  1 , Yan Yang  1 , Qijia Xuan  1 , Jingxuan Wang  1 , Qingyuan Zhang  1
Affiliations

Body Composition as a Predictor of Toxicity and Prognosis in Patients with Diffuse Large B-Cell Lymphoma Receiving R-CHOP Immunochemotherapy

Jiaxun Guo et al. Curr Oncol. .

Abstract

Background: Our study measured the body composition of Diffuse large B-cell lymphoma (DLBCL) patients receiving rituximab with cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) regimen by computed tomographic (CT) and assessed their correlation with treatment-related toxicity and other adverse outcomes.

Methods: We retrospectively analyzed 201 DLBCL patients who underwent pre-treatment abdominal CT examination. CT images were used to assess body composition metrics at the third lumbar vertebrae including fat tissues and muscle. Based on the skeletal muscle area (SMA) and density (SMD), skeletal muscle index (SMI), skeletal muscle gauge (SMG = SMI × SMD) and lean body mass (LBM) were calculated. Also analyzed were the toxicity, adverse events and survival.

Results: We found that SMG, SMD, SMI and LBM were correlated with any grade 3-4 toxicity, dose reduction, hospitalization or termination of the treatment due to immunochemotherapy and worse survival. However, multivariate analysis demonstrated SMG [progression-free survival (PFS): hazard ratio (HR), 2.889; 95% CI, 1.401-5.959; p = 0.004; overall survival (OS): HR, 2.655; 95% CI, 1.218-5.787; p = 0.014] was the best predictor of poor prognosis.

Conclusions: SMG, SMD, SMI and LBM were identified as predictors of adverse reactions and poor survival. SMG was an innovative and valuable indicator of immunochemotherapy toxicity and other adverse outcomes. Additionally, it can be used to individualize antineoplastic drug dosing.

Keywords: diffuse large B-cell lymphoma; immunochemotherapy; sarcopenia; survival; toxicity.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
An example of abdominal computed tomography (CT) image. (A) The original CT image. (B) Skeletal muscle are quantified range of (−29 to + 150 Hounsfield units), and they were outlined along the epimysium that surrounded the muscles.
Figure 2
Figure 2
Risk of toxicity based on body composition. (A) SMG (skeletal muscle gauge), (B) SMD (skeletal muscle density), (C) SMI (skeletal muscle index), (D) LBM (lean body mass).
Figure 3
Figure 3
Kaplan–Meier curves of PFS for patients by body composition. (A) SMG (skeletal muscle gauge), (B) SMD (skeletal muscle density), (C) SMI (skeletal muscle index), (D) LBM (lean body mass).
Figure 4
Figure 4
Kaplan–Meier curves of OS for patients by body composition. (A) SMG (skeletal muscle gauge), (B) SMD (skeletal muscle density), (C) SMI (skeletal muscle index), (D) LBM (lean body mass).
See this image and copyright information in PMC

References

    1. Camicia R., Winkler H.C., Hassa P.O. Novel drug targets for personalized precision medicine in relapsed/refractory diffuse large B-cell lym-phoma: A comprehensive review. Mol. Cancer. 2015;14:207. doi: 10.1186/s12943-015-0474-2. - DOI - PMC - PubMed
    1. Huang J.-J., Xia Y., Wang Y., Liu P.-P., Bi X.-W., Sun P., Lin T.-Y., Jiang W.-Q., Li Z.-M. A comparison of R-EPOCH and R-CHOP as a first-line regimen in de novo DLBCL patients with high Ki-67 expression in a single institution. Oncotarget. 2016;7:41242–41250. doi: 10.18632/oncotarget.9271. - DOI - PMC - PubMed
    1. Testoni M., Zucca E., Young K.H., Bertoni F. Genetic lesions in diffuse large B-cell lymphomas. Ann. Oncol. 2015;26:1069–1080. doi: 10.1093/annonc/mdv019. - DOI - PMC - PubMed
    1. Araie H., Sakamaki I., Matsuda Y., Tai K., Ikegaya S., Itoh K., Kishi S., Oiwa K., Okura M., Tasaki T., et al. 3A Comparison between R-THP-COP and R-CHOP Regimens for the Treatment of Diffuse Large B-cell Lymphoma in Old Patients: A Single-institution Analysis. Intern. Med. 2017;56:2407–2413. doi: 10.2169/internalmedicine.8291-16. - DOI - PMC - PubMed
    1. Intragumtornchai T., Sutheesophon J., Sutcharitchan P., Swasdikul D. A predictive model for life-threatening neutropenia and febrile neutropenia after the first course of CHOP chemotherapy in patients with aggressive non-Hodgkin’s lymphoma. Leuk. Lymphoma. 2000;37:351–360. doi: 10.3109/10428190009089435. - DOI - PubMed

Publication types

MeSH terms

LinkOut - more resources