Association of CVAI, LAP and SMI with risk of haematological toxicity after immunochemotherapy in patients with DLBCL: a retrospective study

Abstract

Background: The occurrence of adverse events after immunochemotherapy in patients with diffuse large B-cell lymphoma (DLBCL) frequently affects the course of chemotherapy, leading to a further decline in quality of life and survival.

Objectives: The primary objective of this study was to investigate the association between Chinese visceral adiposity index (CVAI), lipid accumulation product (LAP) index and skeletal muscle mass index (SMI) at initial diagnosis and the risk of haematological toxicity following immunochemotherapy in patients with DLBCL.

Design: Retrospective, single-centre study.

Methods: CVAI, LAP and SMI were calculated by combining clinical data of the patients. This study included 213 patients, of whom 117 (55%) patients experienced grades 3-4 haematological toxicity after immunochemotherapy. Participants were divided into four groups (Q1, Q2, Q3, Q4) based on the quartiles of CVAI, LAP and SMI.

Results: In the fully adjusted model, the risk of grades 3-4 haematological toxicity in group with the highest CVAI and LAP was reduced by 75.1% (OR: 0.249, 95% CI: 0.102-0.606, p = 0.002) and by 77.3% (OR: 0.227, 95% CI: 0.095-0.542, p = 0.001) compared to the group with the lowest CVAI and LAP. For SMI, the risk of grades 3-4 haematological toxicities in the group with the highest SMI was reduced by 62.9% compared with the lowest SMI group in the unadjusted model. The multivariable-adjusted restricted cubic spline curves and subgroup interaction analyses further confirmed the robustness of these findings.

Conclusion: The results indicate that DLBCL patients with relatively high CVAI, LAP and SMI at initial diagnosis have a lower risk of severe haematological toxicity following chemotherapy. Therefore, CVAI, LAP and SMI at initial diagnosis are reliable and effective biomarkers for predicting severe haematological toxicity after immunochemotherapy in DLBCL patients.

Trial registration: This is a retrospective study, and no registration on ClinicalTrials.gov.

Keywords: Chinese visceral adiposity index; diffuse large B-cell lymphoma; haematological toxicity; immunochemotherapy; lipid accumulation product index; skeletal muscle mass index.

Figure 1.

Abdominal cross-sectional imaging of CT at initial diagnosis were processed using ImageJ software. (a) and (b) are CT planes and selections for waist circumference measurement in abdominal CT of one patient. ① and ② define line lengths based on the ruler in the image. ③ Outline the range of waist circumference. 88.009 in ④ is the length of waist circumference. (c) and (d) are the waist circumference measurement procedures of another patient, where 77.612 is the waist circumference length of this patient.

Figure 2.

Distribution of CVAI (a), LAP (b) and SMI (c) in the occurrence of whether or not serious haematological toxicities. *p < 0.05, **p < 0.01, ***p < 0.001. CVAI, Chinese visceral adiposity index; LAP, lipid accumulation product index; ns, non-significant; SMI, skeletal muscle mass index.

Figure 3.

Restricted cubic spline curves for grade 3–4 haematological toxicity (a–c) and grade 3–4 anaemia(d–f) by CVAI, LAP and SMI after covariate adjustment. Heavy central line represents the estimated adjusted hazard ratio, with shaded ribbons denoting 95% confidence interval. The model is adjusted for age, gender, Ann Arbor stage, IPI score, extranodal involvement, LDH, anthracyclines and alkaloids. CVAI, Chinese visceral adiposity index; IPI, International Prognostic Index; LAP, lipid accumulation product index; LDH, lactate dehydrogenase; SMI, skeletal muscle mass index.

Figure 4.

Subgroup and interaction analyses of the association between CVAI, LAP and SMI (classified by the median) and the risk of grade 3–4 haematological toxicity. CVAI, Chinese visceral adiposity index; LAP, lipid accumulation product index; SMI, skeletal muscle mass index.