Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Division of Hematology & Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Cancer. 2024 Aug 1;130(15):2694-2702. doi: 10.1002/cncr.35298. Epub 2024 Apr 5.
Autologous peripheral blood stem cell transplantation (aPBSCT) is the standard of care for adults with relapsed lymphoma, yet recipients remain at risk of developing chronic health conditions (CHCs). It was hypothesized that body composition measurements of skeletal muscle and fat are associated with late-onset CHCs and nonrelapse mortality after aPBSCT.
Leveraging the Blood or Marrow Transplant Survivor Study, we examined association between pre-aPBSCT body composition and new-onset grade 3-5 CHCs among 187 adults with lymphoma treated with aPBSCT (2011-2014) surviving ≥2 years after aPBSCT. Using computed tomography scans at the L3 level, skeletal muscle mass (skeletal muscle area and skeletal muscle density [SMD]) and body fat (subcutaneous adipose tissue and visceral adipose tissue) were measured and quantified as sex-specific z-scores. Competing risk models were built to study the impact of body composition on incident grade 3 through 5 CHCs and nonrelapse mortality (NRM) adjusting for confounders.
The study cohort had a median age at aPBSCT of 57 years with 63% males, 77% non-Hispanic Whites and 81% with non-Hodgkin lymphoma. The 5-year cumulative incidence of grade 3 through 5 CHCs was 47% (95% Confidence Interval, CI, 38%-56%). Each SD increase in SMD was associated with 30% reduced risk of grade 3 through 5 CHCs (95% CI, 0.50-0.96). The 10-year cumulative incidence of NRM was 16% (95% CI, 10-22). No body composition measure was associated with NRM.
The association between SMD and grade 3 through 5 CHCs following aPBSCT could inform development of prognostic models to identify adults with lymphoma at greatest risk of morbidity following aPBSCT.
自体外周血干细胞移植（aPBSCT）是治疗复发性淋巴瘤成人患者的标准治疗方法，但受者仍有发生慢性健康状况（CHCs）的风险。据推测，骨骼肌和脂肪的身体成分测量与 aPBSCT 后迟发性 CHCs 和非复发死亡率有关。
利用血液或骨髓移植幸存者研究，我们检查了 187 名接受 aPBSCT（2011-2014 年）治疗的淋巴瘤成人患者（aPBSCT 后至少 2 年存活）的 aPBSCT 前身体成分与新发病例 3-5 级 CHCs 之间的相关性。使用 L3 水平的计算机断层扫描，测量和量化骨骼肌质量（骨骼肌面积和骨骼肌密度 [SMD]）和体脂肪（皮下脂肪组织和内脏脂肪组织），并将其量化为性别特异性 z 分数。建立竞争风险模型，以研究身体成分对 3 级至 5 级 CHCs 和非复发死亡率（NRM）的影响，调整混杂因素。
研究队列的 aPBSCT 中位年龄为 57 岁，男性占 63%，非西班牙裔白人占 77%，非霍奇金淋巴瘤占 81%。3 级至 5 级 CHCs 的 5 年累积发生率为 47%（95%置信区间，CI，38%-56%）。SMD 每增加 1 个标准差，3 级至 5 级 CHCs 的风险降低 30%（95%CI，0.50-0.96）。10 年 NRM 的累积发生率为 16%（95%CI，10-22）。没有身体成分测量与 NRM 相关。
aPBSCT 后 SMD 与 3 级至 5 级 CHCs 之间的关联可以为开发预后模型提供信息，以识别 aPBSCT 后发病率最高的淋巴瘤成人患者。
