Predictors of skeletal muscle loss during first-line therapy in diffuse large B-cell lymphoma: the Glasgow Prognostic Score

Abstract

Objectives This study aimed to identify pretreatment factors associated with skeletal muscle mass (SMM) loss during first-line chemotherapy in this population. Methods This single-centre retrospective study included 108 patients aged ≥70 years with diffuse large B-cell lymphoma (DLBCL) who completed first-line rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone or rituximab, cyclophosphamide, tetrahydropyranyl-adriamycin, vincristine, prednisone therapy. Skeletal muscle index (SMI, cm²/m²) was calculated by dividing the cross-sectional muscle area at the third lumbar vertebra on abdominal CT by height squared. The percentage SMI loss was derived from pretreatment and post-treatment measurements. Patients were dichotomised into SMI-loss and SMI-maintained groups using the median SMI loss (5.9%) as the cut-off. Logistic regression was performed using SMI loss as the dependent variable and pretreatment factors as predictors. A sensitivity analysis using the Firth correction was also conducted. Results Among the 108 patients, 54 (50%) were classified into each group. High pretreatment Glasgow Prognostic Score (GPS=2) independently predicted SMI loss (adjusted OR: 2.96; 95% CI 1.17 to 7.53; p=0.023). This association remained significant in the Firth-corrected model (OR: 1.59; 95% CI 1.01 to 2.58; p=0.041). Patients with high GPS more often exhibited B symptoms, elevated lactate dehydrogenase, poor International Prognostic Index scores, reduced performance status (PS) and low haemoglobin. Conclusions Pretreatment GPS may serve as a surrogate marker for SMM loss risk during first-line chemotherapy in elderly patients with DLBCL. Inflammation, malnutrition, reduced physical activity and poor PS may all contribute to SMM loss. Early exercise and nutritional interventions should be considered for patients with high GPS.

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Affiliated Institutions

• Hamamatsu Medical Center JP
• Juntendo University JP
• Keio University JP

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