Lanic Hélène, Kraut-Tauzia Jerôme, Modzelewski Romain, Clatot Florian, Mareschal Sylvain, Picquenot Jean Michel, Stamatoullas Aspasia, Leprêtre Stéphane, Tilly Hervé, Jardin Fabrice
Department of Hematology.
Leuk Lymphoma. 2014 Apr;55(4):817-23. doi: 10.3109/10428194.2013.816421. Epub 2013 Jul 29.
Approximately 25-35% of patients with diffuse large B-cell lymphoma (DLBCL) are older than 70 years. The aim of this study was to investigate the prognostic impact of depletion of skeletal muscle (sarcopenia) in elderly patients with DLBCL. This retrospective analysis included 82 patients with DLBCL older than 70 years and treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, Oncovin, prednisone) or R-miniCHOP. Sarcopenia was measured by the analysis of stored computed tomography (CT) images at the L3 level at baseline. The surface of the muscular tissues was selected according to the CT Hounsfield unit. This value was normalized for stature in order to calculate the lumbar L3 skeletal muscle index (LSMI, in cm(2)/m(2)). The mean age of the population was 78 years. According to the defined cut-offs for LSMI, 45 patients with DLBCL were considered sarcopenic. Sarcopenic patients displayed a higher revised International Prognostic Index (R-IPI) compared with patients without sarcopenia, and were older, with a mean age of 80 years and 77 years, respectively (p = 0.006). With a median follow-up of 39 months, the 2-year overall survival in the sarcopenic population was 46% compared with 84% in the non-sarcopenic group (HR = 3.22; 95% CI = 1.73-5.98; p = 0.0002). In a multivariate analysis, sarcopenia remained predictive of outcome (p = 0.005). Sarcopenia is a relevant and predictive factor in elderly patients with DLBCL treated with rituximab plus chemotherapy.
大约25%-35%的弥漫性大B细胞淋巴瘤（DLBCL）患者年龄超过70岁。本研究的目的是调查骨骼肌减少症（肌少症）对老年DLBCL患者预后的影响。这项回顾性分析纳入了82例年龄超过70岁且接受R-CHOP（利妥昔单抗、环磷酰胺、多柔比星、长春新碱、泼尼松）或R-miniCHOP治疗的DLBCL患者。通过分析基线时L3水平的储存计算机断层扫描（CT）图像来测量肌少症。根据CT亨氏单位选择肌肉组织的表面。该值根据身高进行标准化，以计算腰椎L3骨骼肌指数（LSMI，单位为cm²/m²）。研究人群的平均年龄为78岁。根据LSMI的既定临界值，45例DLBCL患者被认为患有肌少症。与没有肌少症的患者相比，肌少症患者的修订国际预后指数（R-IPI）更高，且年龄更大，平均年龄分别为80岁和77岁（p = 0.006）。中位随访39个月，肌少症人群的2年总生存率为46%，而非肌少症组为84%（HR = 3.22；95%CI = 1.73-5.98；p = 0.0002）。在多变量分析中，肌少症仍然是预后的预测因素（p = 0.005）。肌少症是接受利妥昔单抗加化疗的老年DLBCL患者的一个相关且具有预测性的因素。
