Sarcopenia Determined by Computed Tomography (CT) imaging is a Better Prognosis Factor Than Albuminemia or Charlson Index in Elderly Patients with Diffuse Large B-Cell Lymphoma (DLBCL),
Authors: Kraut Jerome , Modzelewski Romain , Lanic Helene , Loschi Mickael , Alcantara Marion , Picquenot Jean-Michel , Leprêtre Stéphane , Lemasle Emile , Stamatoullas Aspasia , Tilly Herve , Jardin Fabrice 
Published: October 2019

Abstract
Abstract 3681
The prognosis of elderly patients with DLBCL remains particularly poor. The most common explanation involves co-morbidities related to advanced age, which strongly impact chemotherapy feasibility and tolerance. Sarcopenia, defined by the depletion of skeletal muscle, is known to be associated with mortality in individuals with non-malignant diseases but also to be an unfavourable prognosis factor in patients with solid tumors. Its relevance in lymphoma is still unknown. Using a simple and routinely radiological approach, we assessed for the first time the prevalence of sarcopenia and its prognosis value in a population of elderly DLBCL patients.

Patients and methods:
Sarcopenia was retrospectively determined in 40 DLBCL (median age 78.5 y, range 70–88 y, 19 males), characterized as follow: age adjusted IPI 0–1 = 16, 2–3 = 24; treatment by R-CHOP or R-CHOP-like regimen, n = 39; median comorbidity Charlson index = 3 (range 2–7); mean body mass index (BMI; in kg/m2) = 24.1 (40% with obesity or overweight, no patient classified as under weighted). Muscle mass was measured by analysis of stored CT images obtained for diagnostic purposes before any treatment. A lumbar vertebral landmark (L3) was selected because skeletal muscles in this region correspond to whole-body tissue quantities (Janssen et al. J Appl Physiol 2000). To calculate tissue cross sectional area (cm2), the surface of the muscular tissues was selected according to CT Hounsfield unit (range –29 to 150 for skeletal muscles). This value was normalized for stature to calculate the L3 muscle index (LMI, in cm2/m2).

Results:
According to the sex-specific cut-offs for LMI defined in solid tumors (55.4 cm2/m2 for men and 38.9 cm2/m2 for women), 19 DLBCL patients (47.5%,10 males) were considered as sarcopenic. Sarcopenic patients, as compared to non sarcopenic patients displayed a similar level of albuminemia, Charlson index, aaIPI, weight loss, BMI, performance status or B symptoms. By contrast the mean age was 81y in the sarcopenic group and 77y in the non sarcopenic group (p=0.003). With a median follow-up of 39 months, the 2y overall survival in the sarcopenic population was 38% as compared to 70% in the non-sarcopenic group (HR = 0.25; CI95%, 0.1–0.70; p=0.01). The prognostic value remains significant in the subgroup of patients younger than 80y (HR=0.12; CI95% 0.03–0.53; p=0.005). Mortality was mainly related to progressive disease in the sarcopenic group. Hypoalbuminemia tend to be correlated to an unfavourable outcome (p=0.06). In multivariate analysis including albuminemia and aaIPI, sarcopenia remains predictive of the outcome (p=0.03). LMI was also calculated after treatment at least 6 months following initial CT scan (n =30, mean interval =11.8 months, range 6.3–19.2). 11 patients (36%) displayed a reduction (> 5%) and 19 patients (64%) an increase (> 5%) or a stabilisation of the LMI.

Conclusion:
Sarcopenia assessed by CT scan appears as a strong prognosis factor in elderly DLBCL patients, more relevant than usual anthropometrical measures or usual prognostic factors. A prospective multicentric study is currently ongoing to validate these results and to determine if the sarcopenic status should be integrated in future strategies to treat elderly patients.

Disclosures:
No relevant conflicts of interest to declare.