scholarly journals Body Composition as a Predictor of Toxicity and Prognosis in Patients with Diffuse Large B-Cell Lymphoma Receiving R-CHOP Immunochemotherapy

2021 ◽  
Vol 28 (2) ◽  
pp. 1325-1337
Author(s):  
Jiaxun Guo ◽  
Panpan Cai ◽  
Pengfei Li ◽  
Cong Cao ◽  
Jing Zhou ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Body Composition ◽  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Adverse Outcomes ◽  
The Body ◽  
Skeletal Muscle Index ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Background: Our study measured the body composition of Diffuse large B-cell lymphoma (DLBCL) patients receiving rituximab with cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) regimen by computed tomographic (CT) and assessed their correlation with treatment-related toxicity and other adverse outcomes. Methods: We retrospectively analyzed 201 DLBCL patients who underwent pre-treatment abdominal CT examination. CT images were used to assess body composition metrics at the third lumbar vertebrae including fat tissues and muscle. Based on the skeletal muscle area (SMA) and density (SMD), skeletal muscle index (SMI), skeletal muscle gauge (SMG = SMI × SMD) and lean body mass (LBM) were calculated. Also analyzed were the toxicity, adverse events and survival. Results: We found that SMG, SMD, SMI and LBM were correlated with any grade 3–4 toxicity, dose reduction, hospitalization or termination of the treatment due to immunochemotherapy and worse survival. However, multivariate analysis demonstrated SMG [progression-free survival (PFS): hazard ratio (HR), 2.889; 95% CI, 1.401–5.959; p = 0.004; overall survival (OS): HR, 2.655; 95% CI, 1.218–5.787; p = 0.014] was the best predictor of poor prognosis. Conclusions: SMG, SMD, SMI and LBM were identified as predictors of adverse reactions and poor survival. SMG was an innovative and valuable indicator of immunochemotherapy toxicity and other adverse outcomes. Additionally, it can be used to individualize antineoplastic drug dosing.

Correlation Analysis Between Hematological Toxicity and Body Composition in Patients With Diffuse Large B Cell Lymphoma Treated With CHOP±R Regimen

2020 ◽  
Author(s):  
Wenhao Zhao ◽  
Xuelian Liu ◽  
Xiangliang Liu ◽  
Haimei Yang ◽  
Wei Ji ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Hematological Toxicity ◽  
Hematologic Toxicity ◽  
Skeletal Muscle Index ◽  
Large B Cell Lymphoma ◽  
Grade 3 ◽  
Large B Cell

Abstract Purpose: The tolerance of patients withdiffuse large B cell lymphoma（DLBCL） receiving CHOP±R regimen was significantly different, and grade 3~4 hematologic toxicity after chemotherapy in some patients resulted in prolonged hospital stay, increased risk of infection, delayed treatment, and directly or indirectly affected short-term efficacy and long-term prognosis. Lean body mass（LBM）and L3 skeletal muscle index （L3SMI）obtained from abdominal CT of DLBCL patients were analyzed to determine whether they could be used as independent predictors of hematological toxicity of CHOP± R regimen in DLBCL patients.Methods: The patients with DLBCL who underwent CHOP±R regimen at the Cancer Center of the First Hospital of Jilin University from January 2015 to November 2018 were retrospectively analyzed. The abdominal CT of the patient was analyzed by sliceOmatic5.0 software. The third lumbar disc planar imaging was selected, and two consecutive images were taken to calculate LBM and L3SMI. Single factor and multivariate analysis were performed on the correlation of LBM, L3SMIand chemotherapy-related grade 3~4 hematologic toxicity. The ROC curve was drawn to investigate the predictive value of various human indicators on the hematologic toxicity of grade 3~4 related to chemotherapy.Results: The L3 skeletal muscle index is associated with the occurrence of grade 3~4 hematologic toxicity (leukocyte and neutropenia) in patients with diffuse large B-cell lymphoma treated with CHOP±R regimen. Those with lower L3SMI are prone to grade 3~4 hematologic toxicity.LBM is associated with the occurrence of grade 3~4 hematologic toxicity (leukopenia) in patients with diffuse large B-cell lymphoma treated with CHOP±R regimen. This with lower LBM is prone to grade 3~4 hematologic toxicity.The L3 skeletal muscle index can be used as an independent predictor of grade 3~4 hematologic toxicity (leukocyte and neutropenia) in patients with diffuse large B-cell lymphoma treated with CHOP ± R regimen. The cut-off value can be defined as 39.91 cm2/m2.Conclusion: We can draw the following conclusions:The L3 skeletal muscle index is associated with the occurrence of grade 3~4 hematologic toxicity (leukocyte and neutropenia) in patients with diffuse large B-cell lymphoma treated with CHOP±R regimen. Those with lower L3SMI are prone to grade 3~4 hematologic toxicity.LBM is associated with the occurrence of grade 3~4 hematologic toxicity (leukopenia) in patients with diffuse large B-cell lymphoma treated with CHOP±R regimen. This with lower LBM is prone to grade 3~4 hematologic toxicity.The L3 skeletal muscle index can be used as an independent predictor of grade 3~4 hematologic toxicity (leukocyte and neutropenia) in patients with diffuse large B-cell lymphoma treated with CHOP ± R regimen. The cut-off value can be defined as 39.91 cm2/m 2.

scholarly journals Cd5+ Diffuse Large B Cell Lymphoma of the Liver Presenting as Cholestatic Transaminitis.

2021 ◽  
Author(s):  
Taroob Jawad Latef ◽  
Muhammad Bilal ◽  
Sudeep Siddappa Malleshappa ◽  
Chandravathi Loke
Keyword(s):  
B Cell ◽  
Viral Infections ◽  
Cell Lymphoma ◽  
Early Recognition ◽  
Specific Treatment ◽  
B Cell Lymphoma ◽  
The Body ◽  
Large B Cell Lymphoma ◽  
High Index Of Suspicion ◽  
Large B Cell

Abstract A 72-year-old male with nonspecific symptoms was found to have pancytopenia and transaminitis. The pancytopenia began to improve early in the hospital course without specific treatment. A liver biopsy, obtained later to determine the etiology of the transaminitis, eventually confirmed CD5+ diffuse large B cell lymphoma (DLBCL). DLBCL typically presents with painless lymphadenopathy and constitutional symptoms although it may also present as a rapidly enlarging mass in any part of the body. However, in rarer cases its presentation can be misleading. Conditions such as HLH or viral infections, can confound a patient’s presentation and delay the diagnosis. High index of suspicion is warranted for the diagnosis of DLBCL in atypical cases to prevent mortality associated with late diagnosis. Early recognition and biopsy of involved organ, in the absence of clear etiology, is vital for timely diagnosis and prompt treatment to achieve a favorable cure rate. CD5+ DLBCL may have unusual involvement of extra nodal organs such as the liver and may need further investigations.

scholarly journals Diffuse Large B-cell Lymphoma Involving the Skeletal Muscle

2017 ◽  
Vol 56 (10) ◽  
pp. 1269-1270
Author(s):  
Ko Harada ◽  
Kosuke Kimura ◽  
Masaya Iwamuro ◽  
Fumio Otsuka
Keyword(s):  
Skeletal Muscle ◽  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Clinical Relevance Of Cachexia Assessed By An Anthropometric Tool In Elderly Patients With Diffuse Large B-Cell Lymphoma Treated By Immunochemotherapy

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2926-2926
Author(s):  
Helene Lanic ◽  
Jerome Kraut ◽  
Romain Modzelewski ◽  
Florian Clatot ◽  
Jean-Michel Picquenot ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Weight Loss ◽  
Elderly Patients ◽  
Ct Scan ◽  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Background Cancer Cachexia is a metabolic syndrome that can be present even in absence of weight loss and associated with significantly impaired survival. Muscle wasting represents a key-symptom of this syndrome and we recently demonstrated the strong prognosis impact of sarcopenia assessed by computed tomography (CT)-scan in diffuse large B-cell lymphoma (DLBCL) (Lanic et al. Leukemia & Lymphoma 2013). Conversely, the clinical relevance of loss of fat mass (adipopenia) remains unclear. The aim of this study was (i) to investigate the prognostic impact of a multidimensional tool combining a nutritional parameter (albuminemia) and body composition measurements (skeletal muscle and body fat composition) in elderly patients with DLBCL treated by chemotherapy and rituximab (R) (ii) to document the evolution of sarcopenia after immunochemotherapy. Methods This retrospective analysis included 80 DLBCL patients older than 70 years (y) and treated by R-CHOP or R-miniCHOP. Skeletal muscle (SM), visceral (V) and subcutaneal (S) adipose (A) tissues were measured by analysis of stored CT images at the Lumbar vertebrae 3 (L3) level. The surface of the muscular and adipose tissues was selected according to CT Hounsfield unit. Values were normalized for stature to calculate the L3 SM index (LSMI, in cm2/m2), the LVAI and the LSAI and used to define sarcopenia and visceral/subcutaneal adipopenia. Results The characteristics of the patients were as follows: median age = 78 y [70-95]; 36 males; IPI 0-2 = 22, 3-5 = 58; treatment by R-CHOP (n = 45) or R-miniCHOP (n = 35); median body mass index (BMI; in kg/m2) = 23.9. According to the sex-specific defined cut-offs for LSMI (< 55.8 cm²/m² for men and 38.9 cm²/m² for women), 44 DLBCL patients (55 %, 23 males) were considered as sarcopenic. With a median follow-up of 39 months, the 2y overall survival (OS) in the sarcopenic population was 46% as compared to 84% in the non-sarcopenic group (HR = 3.12; CI95%, 1.66-5.88; p=0.0004). The median LSAI was 76.3 cm2/m2 [10-167] in females and 47.4 cm2/m2[22-100] in males. The median LVSAI was 43.5 cm2/m2[3-141] in females and 50.4 cm2/m2[14-159] in males. Adipopenia, defined by a low LVAI and/or a low LSAI was also highly predictive of the outcome. The 2y OS of the low LVAI population was 48% as compared to 82% for the non-adipopenic group (HR = 2.20; CI95%, 1.19-4.05; p=0.01). The 2y OS in the low LSAI population was 48% as compared to 80% in the non-adipopenic group (HR = 2.28; CI95%, 1.23-4.21; p=0.008). A Three-point cachexia score (CS) including adipopenia, sarcopenia and hypo-albuminemia (defined by an albuminemia < 35 g/L) was build and delineates three distinct risk-groups (Figure 1). More importantly the CS remains predictive of the prognosis in a multivariate analysis including BMI (< or >= 25 kg/m2), age (< or >= 80y), IPI and gender (HR=2.5; CI95%= 1.14-5.39; p =0.02). LMSI was subsequently reassessed in thirty seven patients during the routine CT scan follow-up [mean = 10 months after pre-treatment CT scan (range 2.8-19.2)]. 15 (40%) patients displayed a 5% decrease of their LSMI, whereas 13 (35%) and 9 (25%) displayed no significant change or increase (>5%) of the LMSI respectively. Conclusion Our study demonstrates that sarcopenia and adipopenia estimated by CT-scan define cachexia more accurately than BMI or weight loss in elderly DLBCL patients. These factors can be integrated in a cachexia scoring tool which predicts the outcome independently of the BMI and of the IPI. CT scan follow-up indicates that cachexia is a reversible process that should be integrated as part of the therapeutic target in combination with lymphoma treatment. A prospective multicentric trial (registered as NCT01715961/Clinical.gov) is ongoing to validate these anthropometric and nutritional parameters and compare to geriatric assessment scales. Disclosures: No relevant conflicts of interest to declare.

scholarly journals A comparison of pectoralis versus lumbar skeletal muscle indices for defining sarcopenia in diffuse large B-cell lymphoma - two are better than one

Oncotarget ◽  
2017 ◽  
Vol 8 (29) ◽  
pp. 47007-47019 ◽  
Author(s):  
Se-Il Go ◽  
Mi Jung Park ◽  
Haa-Na Song ◽  
Hoon-Gu Kim ◽  
Myoung Hee Kang ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Large B Cell Lymphoma ◽  
Large B Cell ◽  
Better Than

scholarly journals Secondary EBV-positive Diffuse Large B-cell Lymphoma of Skeletal Muscle from EBV-positive Primary Diffuse Large B-cell Lymphoma of Thyroid Gland: Case Report and Literature Review

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Liu C ◽  
◽  
Sun M ◽  
Jiang X ◽  
◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Thyroid Gland ◽  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Lymphoid Malignancy ◽  
Large B Cell Lymphoma ◽  
Primary Focus ◽  
Large B Cell

Diffuse Large B-Cell Lymphoma (DLBCL) is the most common lymphoid malignancy in adults, which often takes a nonlymph nodes organ as the primary focus. Primary lymphoid malignancy of thyroid gland is not common in clinic, EBV-positive primary diffuse large B-cell lymphoma of thyroid gland is rare in clinic, and its pathogenesis, treatment and prognosis are rarely studied. We reported an 85-year-old female patient with EBV-positive primary diffuse large B-cell lymphoma of thyroid gland, and the disease eventually relapsed in skeletal muscle of the patient. The pathological type after relapse was consistent with that of the primary focus. As far as we know secondary EBV-positive DLBCL of skeletal muscle from EBV-positive primary DLBCL of thyroid gland. For elderly patients with multiple adverse prognostic factors, individualized treatment on the premise of ensuring their quality of life may be more important.

scholarly journals An Unusual Case of Extranodal Diffuse Large B-Cell Lymphoma Infiltrating Skeletal Muscle: A Case Report and Review of the Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Joseph Hatem ◽  
Agata M. Bogusz
Keyword(s):  
Skeletal Muscle ◽  
B Cell ◽  
Unusual Case ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Review Of The Literature ◽  
Histologic Subtype ◽  
Large B Cell Lymphoma ◽  
Diagnostic Difficulties ◽  
Large B Cell

Diffuse large B-cell lymphoma is extranodal in approximately 40% of cases, arising in nearly any organ system. DLBCL involvement of soft tissue and in particular skeletal muscle is extremely rare, comprising less than 1% of all extranodal non-Hodgkin lymphomas (NHL). We report a case of a 79-year-old man that presented with a DLBCL of the left triceps. In particular, we describe an unusual histologic appearance of pseudoglandular structures, resembling adenocarcinoma. We performed a review of lymphoma cases involving skeletal muscle diagnosed at our institution over the past 15 years as well as thorough PubMed review of the literature. We discuss the features of lymphoma involving skeletal muscle as it pertains to clinical characteristics, histologic subtype, tumor localization, diagnostic studies, therapy, and outcome. Finally, we highlight the diagnostic difficulties that can present in these rare and often challenging cases.

scholarly journals SUN-915 Diffuse Large B Cell Lymphoma Presents with Femur Fracture and Involvement of Thyroid Gland

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Dakota A McNierney ◽  
Bianca Vazquez ◽  
Mahmood Shahlapour ◽  
Samina Rahman ◽  
Mohamad Hosam Horani
Keyword(s):  
Thyroid Gland ◽  
B Cell ◽  
Germinal Center ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
The Body ◽  
Chop Chemotherapy ◽  
Medical Oncologist ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Diffuse Large B-Cell Lymphoma (DLBCL) is the most common type of Non-Hodgkin Lymphoma worldwide. It is an aggressive lymphoma that arises from germinal center or post-germinal center B cells. Patients typically present with a rapidly enlarging symptomatic mass, most usually nodal enlargement in the neck or abdomen, but may present with a mass lesion anywhere in the body. However, multiple sites of involvement occur less frequently. We report a case of a 74- year-old woman who initially presented to the hospital for evaluation of a right distal femoral fracture which resulted from a fall at home. Lytic lesions were found in the distal femur and proximal fibula. She was also found to have hypercalcemia with a calcium level of 12.2. A CT- guided biopsy confirmed the diagnosis of Diffuse Large B-Cell Lymphoma with non-germinal center phenotype. A radical resection of the right femur was performed, and a distal femoral replacement hinged knee arthroplasty was done successfully. A venous port was also placed for chemotherapy administration. The patient was admitted to inpatient rehab with plans to initiate chemotherapy. 6 weeks later, the patient presented to the emergency department (ED) with a chief complaint of difficulty hearing, ear discomfort, dysphagia, and dyspnea for 3 weeks. These symptoms prompted her medical oncologist to send her to the ED and postpone chemotherapy that was to begin on that day. Physical examination found the patient to have neck fullness, large palpable lymph nodes, and stridor. Upon evaluation she was also found to have impaired renal function (Blood urea nitrogen 41, Cr 3.10), severe hypercalcemia (Corrected calcium 16.2), and hypokalemia (Potassium 2.8). An EKG demonstrated sinus rhythm and non-specific t-wave abnormality. A chest radiograph showed an enlarged thyroid extending into the superior mediastinum. There was also tracheal narrowing, and tracheal deviation to the left. She was admitted to the Intensive Care Unit (ICU) for treatment of hypercalcemia and stridor. The patient was aggressively treated with fluid management. She also received loop diuretics, steroids, and calcitonin. Once stabilized, a fine needle aspiration of the thyroid gland identified further involvement by diffuse B-Cell Lymphoma. The medical oncologist then initiated R-CHOP chemotherapy. The stridor resolved and the patient’s symptoms significantly improved. After two weeks in the ICU she was discharged to a rehab facility where chemotherapy was continued. This is a rare case of rapidly growing non-germinal center DLBCL that presented with involvement of both the bone and thyroid gland causing life-threatening symptoms. Upon reviewing the literature, there has been no documented cases of DLBCL simultaneously involving the bone and thyroid gland. The patient responded well to R- CHOP chemotherapy and continues to receive treatment in an outpatient facility.

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