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Objectives Approximately 30% of DLBCL patients are older than 70 yr. This study evaluated the prognostic impact of a cachexia score ( CS) including fat tissue loss (adipopenia) and sarcopenia as assessed by computed tomography ( CT scan) in elderly DLBCL patients treated with chemotherapy and rituximab ( R). Methods This retrospective analysis included 80 DLBCL patients older than 70 yr treated with R- CHOP or R-mini CHOP. Skeletal muscle ( SM) and visceral ( V) and subcutaneous ( S) adipose ( A) tissues were measured by analysing CT images at the third lumbar ( L3) level. Results The median age of the patients was 78 yr. Forty-four and 46 patients were considered sarcopenic and adipopenic, respectively. The median progression-free survival ( PFS) was 13.6 months in the adipopenic group and 49.4 months in the non-adipopenic group [hazard ratio ( HR) = 2.27; 95% confidence interval ( CI): 1.3-4; P = 0.0042]. The median overall survival ( OS) was 25.7 months in the adipopenic group and 57.1 months in the non-adipopenic group ( HR = 1.93; 95% CI: 1.05-3.55; P = 0.0342). A two-point CS including adipopenia and sarcopenia was created and defined two distinct risk groups with differences in outcomes that were highly significant. The CS was predictive of the prognosis in a multivariate analysis including body mass index ( BMI) (< or ≥25 kg/m2), age (< or ≥80 yr), international prognostic index ( IPI) and albuminaemia ( HR = 3.67; 95% CI = 1.93-6.97; P < 0.0001). Conclusion A CS including sarcopenia and adipopenia, assessed by a single CT scan slice, predicts outcome independent of BMI and the IPI. [ABSTRACT FROM AUTHOR]