Computed tomography-defined sarcopenia: prognostic predictor of nonrelapse mortality after allogeneic hematopoietic stem cell transplantation: a multicenter retrospective study

• Published in: International journal of hematology 2020-07, Vol.112 (1), p.46-56
• Main Authors: Ando, Taiki, Fujisawa, Shin, Teshigawara, Haruka, Matsumura, Ayako, Sakuma, Takayuki, Suzuki, Taisei, Teranaka, Hiroshi, Ogusa, Eriko, Ishii, Yoshimi, Miyashita, Kazuho, Takahashi, Hiroyuki, Nakajima, Yuki, Miyazaki, Takuya, Hagihara, Maki, Matsumoto, Kenji, Yamazaki, Etsuko, Nakajima, Hideaki
• Format: Article
• Language: English
• Subjects: Acute myeloid leukemia; Attenuation; Computed tomography; Graft-versus-host reaction; Hematology; Hematopoietic stem cells; Leukemia; Malignancy; Medicine; Medicine & Public Health; Mortality; Multivariate analysis; Muscles; Myelodysplastic syndrome; Myelodysplastic syndromes; Myeloid leukemia; Oncology; Original Article; Sarcopenia; Skeletal muscle; Stem cell transplantation; Stem cells; Survival; Transplantation
• ISSN: 0925-5710; 1865-3774
• DOI: 10.1007/s12185-020-02870-5

We analyzed clinical cutoffs for defining computed tomography (CT) methods for sarcopenia and examined the prognostic value of CT for allogeneic hematopoietic stem cell transplantation (allo-HCST) outcomes of patients with myeloid malignancy. One hundred twenty-five adult patients with acute myeloid leukemia and myelodysplastic syndrome who underwent first allo-HSCT between 2000 and 2017 were included. Sarcopenia was assessed using CT-based skeletal muscle index (SMI) and mean muscle attenuation at L3. A statistical difference in SMI was confirmed between sarcopenia ( n  = 52) and nonsarcopenia ( n  = 73) patients. There were no significant correlations of muscularity with age, performance status, or other characteristics of HSCT. After 2 years, overall survival (OS) was 43.5% and 70.1%, disease-free survival was 52.9% and 68.6%, nonrelapse mortality (NRM) was 20.8% and 8.4%, incidence of acute GVHD (≥ grade 2) was 38.8% and 39.1%, that of chronic GVHD was 53.2% and 37.3%, and median duration of hospitalization was 88 days and 74 days ( P  = 0.026), respectively, in the sarcopenia and nonsarcopenia groups. Multivariate analysis showed that presence of sarcopenia is a novel adverse factor for high NRM and poor OS. Pretransplant CT-defined sarcopenia is correlated with decreased OS, increased NRM, and prolonged hospitalization.