Body Composition Assessment Provides Prognostic Information in Patients With Cancer Affected by Chronic Graft vs. Host Disease
ABSTRACT Background Additional tools are needed to assess mortality risk among patients with cancer. Patients with chronic graft vs. host disease (cGVHD) after allogeneic haematopoietic cell transplantation (HCT) represent a high‐risk cancer population with mortality risk explained by cGVHD severity...
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Wiley
2025-04-01
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| Series: | Journal of Cachexia, Sarcopenia and Muscle |
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| Online Access: | https://doi.org/10.1002/jcsm.13759 |
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| author | Asmita Mishra Ram Thapa Kevin Bigam Martine Extermann Rawan Faramand Farhad Khimani Xuefeng Wang Vickie Baracos Joseph A. Pidala |
| author_facet | Asmita Mishra Ram Thapa Kevin Bigam Martine Extermann Rawan Faramand Farhad Khimani Xuefeng Wang Vickie Baracos Joseph A. Pidala |
| author_sort | Asmita Mishra |
| collection | DOAJ |
| description | ABSTRACT Background Additional tools are needed to assess mortality risk among patients with cancer. Patients with chronic graft vs. host disease (cGVHD) after allogeneic haematopoietic cell transplantation (HCT) represent a high‐risk cancer population with mortality risk explained by cGVHD severity, but also informed by baseline comorbidities, functional status before and after HCT, and cumulative toxicity from the procedure and its complications. Radiographic body composition metrics from CT scans have previously shown association with complications in other populations. Methods We examined a single‐centre consecutive series (2005–2016) of HCT recipients with cGVHD and CT‐scans immediately proximal to cGVHD diagnosis to investigate association of radiographic body composition measures and mortality. Skeletal muscle index (SMI) and fat index (FI) were quantified on CT imaging at the 3rd lumbar (L3) and 4th thoracic (T4) vertebra. SM Hounsfield units (HU) were obtained to evaluate SM density. Cut points for SMI were from literature and cut points for FI were established by sex‐specific optimal stratification. Results A total of n = 113 patients met the inclusion criteria for this analysis, aged 51.2 ± 10.5(SD) years and predominantly male (n = 71, 63%) and diagnosed with NHL (n = 110, 97%). Onset cGVHD NIH overall severity was mild in N = 56 (49%), moderate in 44 (38%) and severe in 15 (13%), with median time to cGVHD onset after HCT of 173 days [IQR 122;295]. A CT scan at 77 days [IQR 33;202] post HCT was selected for analysis. In multivariate analysis, CT‐defined body fat ≥ 35% was independently associated with increased mortality (HR 2.094 (95% CI 1.060, 4.136), p = 0.033) overall. Patients of male sex had higher FI than females and showed a more prominent association between high FI and mortality. SMI as well as other indices of adiposity were not associated with survival in multivariable analysis including BMI, sarcopenic obesity and low skeletal muscle radiodensity. In exploratory analyses, we demonstrated similar results per CT chest at T4, suggesting possible future application to a larger HCT population. Conclusions These data support that radiographic body composition measures provide prognostic information among patients with cancer affected by cGVHD post‐HCT and suggest that high body fat % is a promising candidate for future study. These findings suggest that low skeletal muscle mass alone does not predict for poor outcomes in HCT patients with cGVHD as previously described in other cancers. Independent validation of this work is needed, including further studies based on CT chest to enhance application to a larger HCT population. |
| format | Article |
| id | doaj-art-de4d592a561c4892bf166723e84cdb90 |
| institution | OA Journals |
| issn | 2190-5991 2190-6009 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Wiley |
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| series | Journal of Cachexia, Sarcopenia and Muscle |
| spelling | doaj-art-de4d592a561c4892bf166723e84cdb902025-08-20T02:35:37ZengWileyJournal of Cachexia, Sarcopenia and Muscle2190-59912190-60092025-04-01162n/an/a10.1002/jcsm.13759Body Composition Assessment Provides Prognostic Information in Patients With Cancer Affected by Chronic Graft vs. Host DiseaseAsmita Mishra0Ram Thapa1Kevin Bigam2Martine Extermann3Rawan Faramand4Farhad Khimani5Xuefeng Wang6Vickie Baracos7Joseph A. Pidala8H. Lee Moffitt Cancer Center Tampa Florida USAH. Lee Moffitt Cancer Center Tampa Florida USAUniversity of Alberta Canada Edmonton Alberta CanadaH. Lee Moffitt Cancer Center Tampa Florida USAH. Lee Moffitt Cancer Center Tampa Florida USAH. Lee Moffitt Cancer Center Tampa Florida USAH. Lee Moffitt Cancer Center Tampa Florida USAUniversity of Alberta Canada Edmonton Alberta CanadaH. Lee Moffitt Cancer Center Tampa Florida USAABSTRACT Background Additional tools are needed to assess mortality risk among patients with cancer. Patients with chronic graft vs. host disease (cGVHD) after allogeneic haematopoietic cell transplantation (HCT) represent a high‐risk cancer population with mortality risk explained by cGVHD severity, but also informed by baseline comorbidities, functional status before and after HCT, and cumulative toxicity from the procedure and its complications. Radiographic body composition metrics from CT scans have previously shown association with complications in other populations. Methods We examined a single‐centre consecutive series (2005–2016) of HCT recipients with cGVHD and CT‐scans immediately proximal to cGVHD diagnosis to investigate association of radiographic body composition measures and mortality. Skeletal muscle index (SMI) and fat index (FI) were quantified on CT imaging at the 3rd lumbar (L3) and 4th thoracic (T4) vertebra. SM Hounsfield units (HU) were obtained to evaluate SM density. Cut points for SMI were from literature and cut points for FI were established by sex‐specific optimal stratification. Results A total of n = 113 patients met the inclusion criteria for this analysis, aged 51.2 ± 10.5(SD) years and predominantly male (n = 71, 63%) and diagnosed with NHL (n = 110, 97%). Onset cGVHD NIH overall severity was mild in N = 56 (49%), moderate in 44 (38%) and severe in 15 (13%), with median time to cGVHD onset after HCT of 173 days [IQR 122;295]. A CT scan at 77 days [IQR 33;202] post HCT was selected for analysis. In multivariate analysis, CT‐defined body fat ≥ 35% was independently associated with increased mortality (HR 2.094 (95% CI 1.060, 4.136), p = 0.033) overall. Patients of male sex had higher FI than females and showed a more prominent association between high FI and mortality. SMI as well as other indices of adiposity were not associated with survival in multivariable analysis including BMI, sarcopenic obesity and low skeletal muscle radiodensity. In exploratory analyses, we demonstrated similar results per CT chest at T4, suggesting possible future application to a larger HCT population. Conclusions These data support that radiographic body composition measures provide prognostic information among patients with cancer affected by cGVHD post‐HCT and suggest that high body fat % is a promising candidate for future study. These findings suggest that low skeletal muscle mass alone does not predict for poor outcomes in HCT patients with cGVHD as previously described in other cancers. Independent validation of this work is needed, including further studies based on CT chest to enhance application to a larger HCT population.https://doi.org/10.1002/jcsm.13759abdominal visceral fatgraft vs. host diseasesarcopenia |
| spellingShingle | Asmita Mishra Ram Thapa Kevin Bigam Martine Extermann Rawan Faramand Farhad Khimani Xuefeng Wang Vickie Baracos Joseph A. Pidala Body Composition Assessment Provides Prognostic Information in Patients With Cancer Affected by Chronic Graft vs. Host Disease Journal of Cachexia, Sarcopenia and Muscle abdominal visceral fat graft vs. host disease sarcopenia |
| title | Body Composition Assessment Provides Prognostic Information in Patients With Cancer Affected by Chronic Graft vs. Host Disease |
| title_full | Body Composition Assessment Provides Prognostic Information in Patients With Cancer Affected by Chronic Graft vs. Host Disease |
| title_fullStr | Body Composition Assessment Provides Prognostic Information in Patients With Cancer Affected by Chronic Graft vs. Host Disease |
| title_full_unstemmed | Body Composition Assessment Provides Prognostic Information in Patients With Cancer Affected by Chronic Graft vs. Host Disease |
| title_short | Body Composition Assessment Provides Prognostic Information in Patients With Cancer Affected by Chronic Graft vs. Host Disease |
| title_sort | body composition assessment provides prognostic information in patients with cancer affected by chronic graft vs host disease |
| topic | abdominal visceral fat graft vs. host disease sarcopenia |
| url | https://doi.org/10.1002/jcsm.13759 |
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