More Pronounced Muscle Loss During Immunochemotherapy is Associated with Worse Clinical Outcomes in Newly Diagnosed Patients with Diffuse Large B-Cell Lymphoma with Unfavorable Features

Marko Lucijanic,1,2 Renata Huzjan Korunic,2,3 Martina Sedinic,1 Rajko Kusec,1,2 Vlatko Pejsa1,2 1Hematology Department, University Hospital Dubrava, Zagreb, Croatia; 2University of Zagreb School of Medicine, Zagreb, Croatia; 3Radiology Department, University Hospital Dubrava, Zagreb, CroatiaCorrespo...

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Autores principales:	Lucijanic M, Huzjan Korunic R, Sedinic M, Kusec R, Pejsa V
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	diffuse large b cell lymphoma sarcopenia psoas muscle r-da-epoch survival Therapeutics. Pharmacology RM1-950
Acceso en línea:	https://doaj.org/article/7676bfeac1784bf2b8ad0db42afce27e
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spelling	oai:doaj.org-article:7676bfeac1784bf2b8ad0db42afce27e2021-12-02T15:17:16ZMore Pronounced Muscle Loss During Immunochemotherapy is Associated with Worse Clinical Outcomes in Newly Diagnosed Patients with Diffuse Large B-Cell Lymphoma with Unfavorable Features1178-203Xhttps://doaj.org/article/7676bfeac1784bf2b8ad0db42afce27e2021-09-01T00:00:00Zhttps://www.dovepress.com/more-pronounced-muscle-loss-during-immunochemotherapy-is-associated-wi-peer-reviewed-fulltext-article-TCRMhttps://doaj.org/toc/1178-203XMarko Lucijanic,1,2 Renata Huzjan Korunic,2,3 Martina Sedinic,1 Rajko Kusec,1,2 Vlatko Pejsa1,2 1Hematology Department, University Hospital Dubrava, Zagreb, Croatia; 2University of Zagreb School of Medicine, Zagreb, Croatia; 3Radiology Department, University Hospital Dubrava, Zagreb, CroatiaCorrespondence: Marko LucijanicHematology Department, University Hospital Dubrava, Av. Gojka Suska 6, Zagreb, 10000, CroatiaEmail markolucijanic@yahoo.comIntroduction: Cancer-induced cachexia is associated with poor prognosis in patients with non-Hodgkin lymphoma, but it is unknown how and to what extent curable lymphoma treatments affect the musculoskeletal system.Patients and Methods: We retrospectively analyzed 104 newly diagnosed diffuse large B-cell lymphoma (DLBCL) patients with unfavorable disease features treated with the R-DA-EPOCH regimen. Psoas muscle area (PMA) measured at L3 vertebra level was compared between staging (pre-therapy) and revision (end of treatment) computerized tomography (CT) scans.Results: Small but significant decline in PMA was observed during the immunochemotherapy period (average loss 5%; P=0.016) with 57.7% of patients experiencing muscle loss. Higher body surface area (OR=17.98 for each m2; P=0.034), number of cycles with dose reduction (OR=2.86 for each cycle; P=0.039) and worse response to therapy (OR=3.09 for each response category; P=0.052) were recognized as independent contributors to the PMA loss in multivariate analysis. One quarter of patients had more pronounced PMA loss (≥ 21%), which was associated with significantly worse overall and progression-free survival. Both ≥ 21% PMA loss and non-achieving response to therapy remained independently associated with inferior OS (PMA loss HR=2.98; P=0.016 and achieving response HR=0.04; P< 0.001) and PFS (PMA loss HR=3.16; P=0.005 and achieving response HR=0.08; P=0.001) in multivariate analyses.Discussion: Muscle loss occurs in approximately half of newly diagnosed DLBCL patients with unfavorable disease features during R-DA-EPOCH immunochemotherapy. If pronounced, this is associated with worse clinical outcomes irrespectively of achieved response to therapy. Muscle loss seems to be mostly affected by the efficacy and tolerability of the regimen.Keywords: diffuse large B-cell lymphoma, sarcopenia, psoas muscle, R-DA-EPOCH, survivalLucijanic MHuzjan Korunic RSedinic MKusec RPejsa VDove Medical Pressarticlediffuse large b cell lymphomasarcopeniapsoas muscler-da-epochsurvivalTherapeutics. PharmacologyRM1-950ENTherapeutics and Clinical Risk Management, Vol Volume 17, Pp 1037-1044 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	diffuse large b cell lymphoma sarcopenia psoas muscle r-da-epoch survival Therapeutics. Pharmacology RM1-950
spellingShingle	diffuse large b cell lymphoma sarcopenia psoas muscle r-da-epoch survival Therapeutics. Pharmacology RM1-950 Lucijanic M Huzjan Korunic R Sedinic M Kusec R Pejsa V More Pronounced Muscle Loss During Immunochemotherapy is Associated with Worse Clinical Outcomes in Newly Diagnosed Patients with Diffuse Large B-Cell Lymphoma with Unfavorable Features
description	Marko Lucijanic,1,2 Renata Huzjan Korunic,2,3 Martina Sedinic,1 Rajko Kusec,1,2 Vlatko Pejsa1,2 1Hematology Department, University Hospital Dubrava, Zagreb, Croatia; 2University of Zagreb School of Medicine, Zagreb, Croatia; 3Radiology Department, University Hospital Dubrava, Zagreb, CroatiaCorrespondence: Marko LucijanicHematology Department, University Hospital Dubrava, Av. Gojka Suska 6, Zagreb, 10000, CroatiaEmail markolucijanic@yahoo.comIntroduction: Cancer-induced cachexia is associated with poor prognosis in patients with non-Hodgkin lymphoma, but it is unknown how and to what extent curable lymphoma treatments affect the musculoskeletal system.Patients and Methods: We retrospectively analyzed 104 newly diagnosed diffuse large B-cell lymphoma (DLBCL) patients with unfavorable disease features treated with the R-DA-EPOCH regimen. Psoas muscle area (PMA) measured at L3 vertebra level was compared between staging (pre-therapy) and revision (end of treatment) computerized tomography (CT) scans.Results: Small but significant decline in PMA was observed during the immunochemotherapy period (average loss 5%; P=0.016) with 57.7% of patients experiencing muscle loss. Higher body surface area (OR=17.98 for each m2; P=0.034), number of cycles with dose reduction (OR=2.86 for each cycle; P=0.039) and worse response to therapy (OR=3.09 for each response category; P=0.052) were recognized as independent contributors to the PMA loss in multivariate analysis. One quarter of patients had more pronounced PMA loss (≥ 21%), which was associated with significantly worse overall and progression-free survival. Both ≥ 21% PMA loss and non-achieving response to therapy remained independently associated with inferior OS (PMA loss HR=2.98; P=0.016 and achieving response HR=0.04; P< 0.001) and PFS (PMA loss HR=3.16; P=0.005 and achieving response HR=0.08; P=0.001) in multivariate analyses.Discussion: Muscle loss occurs in approximately half of newly diagnosed DLBCL patients with unfavorable disease features during R-DA-EPOCH immunochemotherapy. If pronounced, this is associated with worse clinical outcomes irrespectively of achieved response to therapy. Muscle loss seems to be mostly affected by the efficacy and tolerability of the regimen.Keywords: diffuse large B-cell lymphoma, sarcopenia, psoas muscle, R-DA-EPOCH, survival
format	article
author	Lucijanic M Huzjan Korunic R Sedinic M Kusec R Pejsa V
author_facet	Lucijanic M Huzjan Korunic R Sedinic M Kusec R Pejsa V
author_sort	Lucijanic M
title	More Pronounced Muscle Loss During Immunochemotherapy is Associated with Worse Clinical Outcomes in Newly Diagnosed Patients with Diffuse Large B-Cell Lymphoma with Unfavorable Features
title_short	More Pronounced Muscle Loss During Immunochemotherapy is Associated with Worse Clinical Outcomes in Newly Diagnosed Patients with Diffuse Large B-Cell Lymphoma with Unfavorable Features
title_full	More Pronounced Muscle Loss During Immunochemotherapy is Associated with Worse Clinical Outcomes in Newly Diagnosed Patients with Diffuse Large B-Cell Lymphoma with Unfavorable Features
title_fullStr	More Pronounced Muscle Loss During Immunochemotherapy is Associated with Worse Clinical Outcomes in Newly Diagnosed Patients with Diffuse Large B-Cell Lymphoma with Unfavorable Features
title_full_unstemmed	More Pronounced Muscle Loss During Immunochemotherapy is Associated with Worse Clinical Outcomes in Newly Diagnosed Patients with Diffuse Large B-Cell Lymphoma with Unfavorable Features
title_sort	more pronounced muscle loss during immunochemotherapy is associated with worse clinical outcomes in newly diagnosed patients with diffuse large b-cell lymphoma with unfavorable features
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/7676bfeac1784bf2b8ad0db42afce27e
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More Pronounced Muscle Loss During Immunochemotherapy is Associated with Worse Clinical Outcomes in Newly Diagnosed Patients with Diffuse Large B-Cell Lymphoma with Unfavorable Features

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