The Geriatric Syndrome of Sarcopenia Impacts Allogeneic Hematopoietic Cell Transplantation Outcomes in Combination with Multi-Morbidity and Functional Impairment

• Published in: Blood 2019-11, Vol.134 (Supplement_1), p.4508-4508
• Main Authors: Lin, Richard J, Michaud, Laure, Lobaugh, Stephanie M, Nakajima, Reiko, Elko, Theresa A, Ruiz, Josel D, Sauter, Craig S., Dahi, Parastoo B., Maloy, Molly A., Perales, Miguel-Angel, Kim, Soo Jung, Korc-Grodzicki, Beatriz, Devlin, Sean M., Scordo, Michael, Schoder, Heiko, Giralt, Sergio A, Hamlin, Paul A.
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2019-125141

Older patients with advanced hematologic malignancies are increasingly considered for allogeneic hematopoietic cell transplantation (allo-HCT). However, survival outcomes, especially non-relapse mortality (NRM) in these patients remain suboptimal due to multi-morbidity and geriatric vulnerabilities. We and others have shown previously that pre-transplant multi-morbidity, and functional limitation and post-HCT geriatric syndromes of delirium and fall significantly impact allo-HCT outcomes. Sarcopenia, an accelerated loss of muscle mass and function, has been increasingly recognized to affect HCT outcomes. However, it remains unknown whether sarcopenia is a simple surrogate of multi-morbidity or functional impairment and whether post-transplant sarcopenia also impacts outcomes. From our institutional database and the electronic medical record, we identified 146 lymphoma patients 50 years or older who were transplanted at our institution from 2008 to 2018 using reduced-intensity/nonmyeloablative conditioning and a matched related or unrelated, mismatched unrelated, or haploidentical donor, and who had either a PETCT or CT within 60 days of HCT. Two adjacent axial images within the same series at the third lumbar vertebra were selected for the analysis of total muscle cross-sectional area (cm2) and of total fat (subcutaneous and visceral adipose tissues) cross-sectional area (cm2) using MIM software. Skeletal muscle cross-sectional area was normalized for stature and reported as skeletal muscle index in cm2/m2. Sarcopenia was defined as a skeletal muscle index