Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
Department of Blood Transfusion, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
J Cachexia Sarcopenia Muscle. 2024 Jun;15(3):1094-1107. doi: 10.1002/jcsm.13449. Epub 2024 Mar 25.
Sarcopenia is a potential risk factor for adverse outcomes in haematopoietic cell transplantation (HSCT) recipients. We aimed to explore longitudinal body changes in muscle and adipose mass and their prognostic value in allogeneic HSCT-treated severe aplastic anaemia (SAA) patients.
We retrospectively analysed consecutive SAA patients who underwent allogeneic HSCT between January 2017 and March 2022. Measurements of pectoral muscle and corresponding subcutaneous fat mass were obtained via chest computed tomography at baseline and at 1 month, 3 months, 6 months, and 12 months following HSCT. Sarcopenia was defined as pectoral muscle index (PMI) lower than the sex-specific median at baseline. Changes in body composition over time were evaluated by generalized estimating equations. Cox regression models were used to investigate prognostic factors affecting overall survival (OS) and failure-free survival (FFS). A nomogram was constructed from the Cox regression model for OS.
We included 298 adult SAA patients (including 129 females and 169 males) with a median age of 31 years [interquartile range (IQR), 24-39 years] at baseline. Sarcopenia was present in 148 (148/298, 50%) patients at baseline, 218 (218/285, 76%) patients post-1 month, 209 (209/262, 80%) patients post-3 month, 169 (169/218, 78%) patients post-6 month, and 129 (129/181, 71%) patients post-12 month. A significant decrease in pectoral muscle mass was observed in SAA patients from the time of transplant to 1 year after HSCT, and the greatest reduction occurred in post 1-3 months (P < 0.001). The sarcopenia group exhibited significantly lower 5-year OS (90.6% vs. 100%, log-rank P = 0.039) and 5-year FFS (89.2% vs. 100%, log-rank P = 0.021) than the nonsarcopenia group at baseline. Sarcopenia at baseline (hazard ratio, HR, 6.344; 95% confidence interval, CI: 1.570-25.538; P = 0.01; and HR, 3.275; 95% CI: 1.159-9.252; P = 0.025, respectively) and the delta value of the PMI at 6 months post-transplantation (ΔPMI6) (HR, 0.531; 95% CI: 0.374-0.756; P < 0.001; and HR, 0.666; 95% CI: 0.505-0.879; P = 0.004, respectively) were demonstrated to be independent prognostic factors for OS and FFS in SAA patients undergoing HSCT, and were used to construct the nomogram. The C-index of the nomogram was 0.75, and the calibration plot showed good agreement between the predictions made by the nomogram and actual observations.
Sarcopenia persists in SAA patients from the time of transplant to the 1-year follow-up after HSCT. Both sarcopenia at baseline and at 6 months following HSCT are associated with poor clinical outcomes, especially in patients with persistent muscle mass loss up to 6 months after transplantation.
肌肉减少症是造血细胞移植（HSCT）受者不良结局的潜在风险因素。我们旨在探索肌肉和脂肪质量的纵向变化及其在所有接受同种异体 HSCT 治疗的严重再生障碍性贫血（SAA）患者中的预后价值。
我们回顾性分析了 2017 年 1 月至 2022 年 3 月期间接受同种异体 HSCT 的连续 SAA 患者。在 HSCT 后 1 个月、3 个月、6 个月和 12 个月时，通过胸部计算机断层扫描获得胸肌和相应皮下脂肪质量的测量值。在基线时，将胸肌指数（PMI）低于性别特异性中位数定义为肌肉减少症。使用广义估计方程评估随时间变化的身体成分变化。Cox 回归模型用于研究影响总生存（OS）和无失败生存（FFS）的预后因素。从 Cox 回归模型构建 OS 的列线图。
我们纳入了 298 名成年 SAA 患者（包括 129 名女性和 169 名男性），基线时的中位年龄为 31 岁[四分位距（IQR），24-39 岁]。基线时，148 名（148/298，50%）患者存在肌肉减少症，1 个月后 218 名（218/285，76%）患者，3 个月后 209 名（209/262，80%）患者，6 个月后 169 名（169/218，78%）患者，12 个月后 129 名（129/181，71%）患者。从移植到 HSCT 后 1 年，SAA 患者的胸肌质量明显减少，最大减少发生在移植后 1-3 个月（P<0.001）。与非肌肉减少症组相比，基线时肌肉减少症组的 5 年 OS（90.6%对 100%，对数秩 P=0.039）和 5 年 FFS（89.2%对 100%，对数秩 P=0.021）明显较低。基线时的肌肉减少症（危险比，HR，6.344；95%置信区间，CI：1.570-25.538；P=0.01；和 HR，3.275；95%CI：1.159-9.252；P=0.025，分别）和移植后 6 个月的 PMI 差值（ΔPMI6）（HR，0.531；95%CI：0.374-0.756；P<0.001；和 HR，0.666；95%CI：0.505-0.879；P=0.004，分别）被证明是接受 HSCT 的 SAA 患者 OS 和 FFS 的独立预后因素，并用于构建列线图。该列线图的 C 指数为 0.75，校准图显示该列线图的预测与实际观察结果之间具有良好的一致性。
从移植到 HSCT 后 1 年的随访，SAA 患者一直存在肌肉减少症。基线时和 HSCT 后 6 个月的肌肉减少症与不良临床结局相关，尤其是在移植后 6 个月内持续肌肉质量损失的患者中。
