Cachexia at Diagnosis adversely predicts outcomes in patients with Aggressive B-Cell NHL receiving standard of care treatment: A Prospective Observational Study from India
Authors: Radhakrishnan Vivek S , Nair Reena , Patra Anwesha , Bhave Saurabh Jayant , Garg Jeevan Kumar , Mallath Mohandas 
Published: November 2019

Background and Objectives:Cancer associated malnutrition and cachexia is an important determinant of the patient's short and long term outcomes. This prospective study was conducted to determine the association between cachexia at diagnosis and overall survival of patients with aggressive B-cell non-Hodgkin's Lymphoma (ABNHL)

Methods:This investigator initiated single centre prospective observational study was conducted at the Tata Medical Center, Kolkata, India between Jan 2015 and Mar 2019 after IRB approval. Patients diagnosed with ABNHL receiving standard of care chemo-immunotherapy were eligible. This study was supported by an educational research grant from Baxter to our institution. All patients who consented to participate were screened for cachexia at entry using a modified Subjective Global Assessment (SGA) tool (1). Baseline clinical factors of prognostic importance including stage, IPI score, etc. were recorded. All statistical analysis was carried out using EpiInfo-ver.7 software.

Results:239 patients diagnosed with high grade B-NHL were recruited. The study group included 89 women and 150 men, and 77 (32.1%) were older than 65 years. 130 (54.3%) patients received private care. 88(36.8%) had IPI stage high-intermediate plus high grade; 136 (56.9%) had Ann Arbor stage III plus IV disease; 40 (16.7%) had extra-nodal NHL; 96 (40.1%) had weight loss and 107(44.7%) had reduced food intake. Cachexia scores estimated by the modified SGA tool was SGA-A in 101, SGA-B in 120 and SGA-C in 18 patients. Only 37 (15.4%) had been subjected to screening for malnutrition prior to cancer treatment. 44 (20.5%) patients experienced neutropenic sepsis during treatment. At a median follow up of 457 days, 69% achieved complete remission at the end of initial therapy, 50 (20.9%) patients died during the study period. In univariate analysis, SGA, IPI, Stage and age groups were statistically significant prognostic markers. The 2-year actuarial survival of all patients adjusted for SGA, IPI and Stage was 72%. The two-year actuarial survival in the SGA-A, SGA-B, and SGA-C groups were respectively 80%, 68% and 45% (p<0.001). In a multivariate analysis using cox proportional hazards method the hazard ratio for SGA B was 1.67 (0.94-2.97), and SGA-C was 3.65, after adjusting for IPI and stage groups (p=0.0137).The follow up is continuing and final multivariate analysis will be done when sufficient events have occurred.

Conclusions:Cachexia at diagnosis is an important independent prognostic biomarker in patients with ABNHL. The role of routine screening for cachexia before initiating treatments and providing individualized medical nutrition therapy along with physical therapy during chemotherapy to prevent worsening of cachexia and improve survival needs evaluation.

References: 1.Shirodkar M etal, Indian J Gastroenterol.2005; 24:246-50

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Disclosures

Patra: Baxter: Research Funding. Mallath:Otsuka Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees; Pfizer: Speakers Bureau; GlaxoSmithKline: Research Funding; Baxter: Research Funding; Otsuka Pharmaceuticals: Honoraria; Bristol-Myers Squibb: Honoraria; Bayer-Zydus Pharma: Honoraria; Sayre-Therapeutics: Honoraria.