DLBCL survivors at risk for long-term sarcopenia, visceral obesity

Survivors of diffuse large B-cell lymphoma frequently experienced unfavorable long-term body composition changes, including visceral obesity and sarcopenia, according to longitudinal study results.

A prior study showed survivors of diffuse large B-cell lymphoma (DLBCL) initially lost weight but ultimately experienced substantial weight gain in the first 2 years after treatment.

“Body composition parameters are associated with long-term health outcomes, making treatment-related body composition changes an important issue for DLBCL survivorship,” Kenneth R. Carson, MD, PhD, assistant professor of medicine at Washington University School of Medicine in St. Louis, and colleagues wrote. “As a result, knowledge of body composition changes occurring during the course of chemotherapy could play an integral role in guiding survivorship care planning and subsequent lifestyle interventions.”

Carson and colleagues retrospectively studied a cohort of 342 U.S. veterans (mean age, 63.4 ± 11.2 years; 96.8% men) treated for DLBCL.

All patients received cyclophosphamide, doxorubicin, vincristine and prednisone, with or without rituximab (Rituxan; Genentech, Biogen), and had at least one posttreatment scan available.

The researchers used CT data to measure visceral fat, subcutaneous fat and muscle area.

Patients experienced a 2.8% (4.8 cm²) reduction in skeletal muscle area from baseline to the end of treatment (173.6 cm² vs. 168.8 cm²); however, area returned to baseline levels by 24 months after treatment (176.1 cm²).

Subcutaneous adipose tissue area increased by 6.5% (95% CI, 2.6-10.5) at treatment completion (197.3 cm² vs. 185.2 cm²). By 24 months, it increased by 21.4% (95% CI, 15.7-27.2) to 224.8 cm².

Similarly, visceral fat area increased by 4.5% (95% CI, –0.9 to 9.9) by the end of treatment (196.6 cm² vs. 188.1 cm²), and by 21.6% (95% CI, 14.8-28.4) to 228.7 cm² by 24 months after treatment.

More than one-third (37.9%) of patients were classified as sarcopenic at 24 months after treatment, 20.7% of whom were newly sarcopenic. Factors associated with sarcopenia included baseline sarcopenia (adjusted OR = 17.21; 95% CI, 8.48-34.94), age older than 60 years (adjusted OR = 2.93; 95% CI, 1.46-5.88) and weight loss greater than 5% during treatment (adjusted OR = 2.4; 95% CI, 1.12-5.14).

Weight gain greater than 5% during treatment correlated with long-term visceral obesity (adjusted OR = 4.6; 95% CI, 2.42-8.74).

The researchers acknowledged study limitations, including the racial and sexual homogeneity of the study population. The original cohort included 1,445 potentially eligible patients; however, 40% were excluded due to lack of CT scans.

The researchers also could not measure muscle function — part of the consensus definition for sarcopenia — due to the study’s retrospective nature.

“This is the first study to describe body composition changes during and after chemotherapy treatment in the DLBCL population,” Carson and colleagues wrote. “Patients at highest risk for the long-term development of either sarcopenia or visceral adiposity can be identified by clinical characteristics available at the end of treatment. These high-risk patients could be targeted for individualized lifestyle interventions designed to improve their body composition parameters.” – by Cameron Kelsall

Disclosure: The researchers report no relevant financial disclosures.