Clinical and prognostic role of sarcopenia in elderly patients with classical Hodgkin lymphoma: a multicentre experience

Abstract Background Elderly classical Hodgkin lymphoma (cHL) (ecHL) is a rare disease with dismal prognosis and no standard treatment. Fitness‐based approaches may help design appropriate treatments. Sarcopenia has been associated with an increased risk of treatment‐related toxicities and worse surv...

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Main Authors: Vittorio Ruggero Zilioli, Domenico Albano, Annalisa Arcari, Francesco Merli, Alessandra Coppola, Giulia Besutti, Luigi Marcheselli, Doriana Gramegna, Cristina Muzi, Moana Manicone, Manuela Camalori, Patrizia Ciammella, Giuseppe Colloca, Alessandra Tucci
Format: Article
Language:English
Published: Wiley 2021-08-01
Series:Journal of Cachexia, Sarcopenia and Muscle
Subjects:
Online Access:https://doi.org/10.1002/jcsm.12736
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author Vittorio Ruggero Zilioli
Domenico Albano
Annalisa Arcari
Francesco Merli
Alessandra Coppola
Giulia Besutti
Luigi Marcheselli
Doriana Gramegna
Cristina Muzi
Moana Manicone
Manuela Camalori
Patrizia Ciammella
Giuseppe Colloca
Alessandra Tucci
spellingShingle Vittorio Ruggero Zilioli
Domenico Albano
Annalisa Arcari
Francesco Merli
Alessandra Coppola
Giulia Besutti
Luigi Marcheselli
Doriana Gramegna
Cristina Muzi
Moana Manicone
Manuela Camalori
Patrizia Ciammella
Giuseppe Colloca
Alessandra Tucci
Clinical and prognostic role of sarcopenia in elderly patients with classical Hodgkin lymphoma: a multicentre experience
Journal of Cachexia, Sarcopenia and Muscle
Hodgkin lymphoma
Sarcopenia
Geriatric assessment
Elderly
author_facet Vittorio Ruggero Zilioli
Domenico Albano
Annalisa Arcari
Francesco Merli
Alessandra Coppola
Giulia Besutti
Luigi Marcheselli
Doriana Gramegna
Cristina Muzi
Moana Manicone
Manuela Camalori
Patrizia Ciammella
Giuseppe Colloca
Alessandra Tucci
author_sort Vittorio Ruggero Zilioli
title Clinical and prognostic role of sarcopenia in elderly patients with classical Hodgkin lymphoma: a multicentre experience
title_short Clinical and prognostic role of sarcopenia in elderly patients with classical Hodgkin lymphoma: a multicentre experience
title_full Clinical and prognostic role of sarcopenia in elderly patients with classical Hodgkin lymphoma: a multicentre experience
title_fullStr Clinical and prognostic role of sarcopenia in elderly patients with classical Hodgkin lymphoma: a multicentre experience
title_full_unstemmed Clinical and prognostic role of sarcopenia in elderly patients with classical Hodgkin lymphoma: a multicentre experience
title_sort clinical and prognostic role of sarcopenia in elderly patients with classical hodgkin lymphoma: a multicentre experience
publisher Wiley
series Journal of Cachexia, Sarcopenia and Muscle
issn 2190-5991
2190-6009
publishDate 2021-08-01
description Abstract Background Elderly classical Hodgkin lymphoma (cHL) (ecHL) is a rare disease with dismal prognosis and no standard treatment. Fitness‐based approaches may help design appropriate treatments. Sarcopenia has been associated with an increased risk of treatment‐related toxicities and worse survival in various solid tumours, but its impact in ecHL is unknown. The aim of this retrospective multicentre study was to investigate the prognostic role of sarcopenia in ecHL. Methods We included newly diagnosed >64 years old cHL patients who performed a baseline comprehensive geriatric assessment and high‐dose computed tomography (CT) or 18fluorine‐fluorodeoxyglucose positron emission tomography/CT before any treatment. Sarcopenia was measured as skeletal muscle index (SMI, cm2/m2) by the analysis of high‐dose CT or low‐dose positron emission tomography/CT images at the L3 level. The specific cut‐offs for the SMI were determined by receiver operator curve analysis and compared with those proposed in literature and studied in diffuse large B‐cell lymphoma. Survival functions [progression‐free survival [PFS] and overall survival (OS)] were calculated for the whole population and for different subgroups defined as per different sarcopenia cut‐off levels. Results We included 154 patients (median age 71 years old, 76 female). The median L3‐SMI was 42 cm2/m2. The specific cut‐off derived in our male population was 45 cm2/m2; using this cut‐off, 27 male patients (35%) were defined as sarcopenic. After a median follow‐up of 5.9 years, the overall 5‐year PFS and OS rates were 53% and 65%, respectively, and were significantly shorter in sarcopenic male patients compared with non‐sarcopenic (PFS 31% vs. 61%, P = 0.008; OS 51% vs. 74%, P = 0.042). Applying diffuse large B‐cell lymphoma‐derived sarcopenic thresholds, there were no significant differences between sarcopenic and non‐sarcopenic patients for both PFS and OS, with a sole exception of a significant reduced PFS in sarcopenic male patients using Namakura cut‐off. The comprehensive geriatric assessment‐determined frail functional status was an independent adverse prognostic factor for both female and male patients. Conclusions Baseline evaluation of sarcopenia through radiological examinations performed for ecHL staging may help define a proportion of male patients with unfavourable outcome with current treatment strategies. Also the functional status evaluation could allow to identify a frail subgroup of patients with worse outcome.
topic Hodgkin lymphoma
Sarcopenia
Geriatric assessment
Elderly
url https://doi.org/10.1002/jcsm.12736
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spelling doaj-c1ecd01e0d804cc2a6b8c4f8943cfc472021-08-09T05:46:56ZengWileyJournal of Cachexia, Sarcopenia and Muscle2190-59912190-60092021-08-011241042105510.1002/jcsm.12736Clinical and prognostic role of sarcopenia in elderly patients with classical Hodgkin lymphoma: a multicentre experienceVittorio Ruggero Zilioli0Domenico Albano1Annalisa Arcari2Francesco Merli3Alessandra Coppola4Giulia Besutti5Luigi Marcheselli6Doriana Gramegna7Cristina Muzi8Moana Manicone9Manuela Camalori10Patrizia Ciammella11Giuseppe Colloca12Alessandra Tucci13Division of Hematology ASST Grande Ospedale Metropolitano Niguarda Milan ItalyDivision of Nuclear Medicine ASST Spedali Civili Brescia ItalyDivision of Hematology Ospedale Guglielmo da Saliceto Piacenza ItalyDivision of Hematology Azienda USL—IRCCS di Reggio Emilia Reggio Emilia ItalyDivision of Radiology ASST Grande Ospedale Metropolitano Niguarda Milan ItalyDivision of Radiology Azienda USL—IRCCS di Reggio Emilia Reggio Emilia ItalyFondazione Italiana Linfomi Onlus Trial Office Modena Modena ItalyDivision of Hematology ASST Spedali Civili Brescia ItalyDivision of Hematology ASST Grande Ospedale Metropolitano Niguarda Milan ItalyClinical and Experimental PhD Program University of Modena and Reggio Emilia Modena ItalyDivision of Radiology ASST Grande Ospedale Metropolitano Niguarda Milan ItalyDivision of Radiotherapy Azienda USL—IRCCS di Reggio Emilia Reggio Emilia ItalyDivision of Geriatrics Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Rome ItalyDivision of Hematology ASST Spedali Civili Brescia ItalyAbstract Background Elderly classical Hodgkin lymphoma (cHL) (ecHL) is a rare disease with dismal prognosis and no standard treatment. Fitness‐based approaches may help design appropriate treatments. Sarcopenia has been associated with an increased risk of treatment‐related toxicities and worse survival in various solid tumours, but its impact in ecHL is unknown. The aim of this retrospective multicentre study was to investigate the prognostic role of sarcopenia in ecHL. Methods We included newly diagnosed >64 years old cHL patients who performed a baseline comprehensive geriatric assessment and high‐dose computed tomography (CT) or 18fluorine‐fluorodeoxyglucose positron emission tomography/CT before any treatment. Sarcopenia was measured as skeletal muscle index (SMI, cm2/m2) by the analysis of high‐dose CT or low‐dose positron emission tomography/CT images at the L3 level. The specific cut‐offs for the SMI were determined by receiver operator curve analysis and compared with those proposed in literature and studied in diffuse large B‐cell lymphoma. Survival functions [progression‐free survival [PFS] and overall survival (OS)] were calculated for the whole population and for different subgroups defined as per different sarcopenia cut‐off levels. Results We included 154 patients (median age 71 years old, 76 female). The median L3‐SMI was 42 cm2/m2. The specific cut‐off derived in our male population was 45 cm2/m2; using this cut‐off, 27 male patients (35%) were defined as sarcopenic. After a median follow‐up of 5.9 years, the overall 5‐year PFS and OS rates were 53% and 65%, respectively, and were significantly shorter in sarcopenic male patients compared with non‐sarcopenic (PFS 31% vs. 61%, P = 0.008; OS 51% vs. 74%, P = 0.042). Applying diffuse large B‐cell lymphoma‐derived sarcopenic thresholds, there were no significant differences between sarcopenic and non‐sarcopenic patients for both PFS and OS, with a sole exception of a significant reduced PFS in sarcopenic male patients using Namakura cut‐off. The comprehensive geriatric assessment‐determined frail functional status was an independent adverse prognostic factor for both female and male patients. Conclusions Baseline evaluation of sarcopenia through radiological examinations performed for ecHL staging may help define a proportion of male patients with unfavourable outcome with current treatment strategies. Also the functional status evaluation could allow to identify a frail subgroup of patients with worse outcome.https://doi.org/10.1002/jcsm.12736Hodgkin lymphomaSarcopeniaGeriatric assessmentElderly