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BACKGROUND Quantification of skeletal muscle using computed tomography (CT) is accessible using cancer patients' standard oncologic images. Reduced muscle mass may be related to reduced respiratory muscle strength; however, the impact of this on lung functional parameters is not characterized in adult allogeneic haematopoietic stem cell transplant (alloHCT) recipients. METHODS A consecutive retrospective series (n = 296) of patients who had alloHCT at a comprehensive cancer centre between March 2005 and April 2015 were included. Pre-transplant CT scans were used to quantify skeletal muscle and adipose tissue at the fourth thoracic (T4) and/or third lumbar (L3) level. Tumour and patient characteristics were recorded, including forced expiratory volume in 1 second (FEV1 ) by spirometry. Regression models were created to characterize predictive relationships. RESULTS A total of 296 patients (♂n = 161; ♀n = 135) were included, all of whom had chest CT as part of standard care; a subset of these (n = 215, 72.6%) also had abdominal CT. Diagnoses were non-Hodgkins lymphoma (n = 165), acute myeloid leukaemia (n = 66), Hodgkin's disease (n = 14), acute lymphocytic leukaemia (n = 14), myelodysplastic syndromes (n = 18), and other (n = 19). In multivariable linear regression adjusted for sex (P

Background Additional tools for risk-stratification of chronic graft vs. host disease (cGVHD) may enhance the established NIH consensus-based severity score. Radiographic body composition metrics arising from standardly performed CT-scans have previously shown significant association with treatment complications in other cancer populations. We aimed to characterize skeletal muscle (SM) and adiposity in cGVHD patients to discern potential association with subsequent mortality. Methods A consecutive retrospective series of patients who underwent allogeneic hematopoietic cell transplantation (HCT) at our center from 2005-2016 and had the following criteria were evaluated: 1) diagnosis of either non-Hodgkin (NHL) or Hodgkin Lymphoma (HL) to enrich for available CT, and 2) had a history of cGVHD. 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 and FI were done via gender specific optimal stratification. Results A total of n=115 patients met the inclusion criteria for this analysis. The median age was 52 (range 22-69), and patients were predominantly male (n=71, 62%) and diagnosed with NHL (n=110, 96%). Onset cGVHD NIH overall severity was mild in N=56 (49%), moderate in 44 (38%), and severe in 15 (13%). When considering all body composition parameters, high L3 fat index (FI) at D100 was associated with worsened OS (HR 2.83, 95% CI 1.30, 6.12, p=0.008), but SMI and SM HU were not associated with OS (p=NS). In multivariate analysis, high L3 FI was independently associated with increased mortality (HR 2.29, 95% CI 1.03-5.1, p=0.043) (Table 1), while SMI and HU were not (p=NS). In secondary analysis, we quantified the change in body composition in evaluable patients (n=72). Cachexia development was observed from pre- to post-HCT (median % weight change -5.5 [-50.1-13.3]. The majority of patients had decline in both FI and SMI (Figure 1). These changes were also seen in CT chest with high correlation between SMI and FI when comparing CT abdomen chest r=0.854 and r=0.798 respectively. Conclusions Increased FI is associated with worsened overall survival in cGVHD patients, while SMI and HU are not. These findings suggest that low skeletal muscle mass alone does not predict for poor outcomes in cGVHD as previously described in other cancers. Body composition analysis in a larger cGVHD cohort is needed to confirm these findings and examine risk-stratification within NIH severity groups.

Background Precise quantification of skeletal muscle using computed tomography is accessible using cancer patients' standard oncologic images. Reduced muscle mass (i.e. sarcopenia) has been related to mortality, treatment complications and QOL and reduced respiratory muscle strength, however these associations are not well characterized in adult alloHSCT recipients. Methods A consecutive retrospective series (n=296) patients who had allogeneic BMT at a comprehensive Center between 01/2016 and 12/2017. Pre-transplant CT scans were used to quantify skeletal muscle and adipose tissue at the 3rd lumbar (L3) and/or 4th thoracic (T4) vertebra. Tumor and patient characteristics were recorded, including FEV1 by spirometry. Sarcopenia was defined according to Prado et al. (PMID:18539529) Results 296 patients (male n=161; female n=135) were included, all of whom had thoracic-CT; a subset of these (n=195) also had lumbar-CT. Diagnoses were NHL (n=172), AML (n=66) HD (n=14), ALL (n=14), MDS (n=18) and other (MM, MPN, CML; n=12). Patients had increased BMI (male= 28.7 kg/m2, female=26.5 kg/m2), with many patients (♂64.7%; ♀57.0%) meeting criteria for sarcopenia. Rates of sarcopenia were higher (p Men and women were more muscular at T4 than L3. L3 and T4 skeletal muscle areas were moderately correlated (r2 =0.33- 0.47), as were L3 and T4 muscle radiodensities (r2 =0.58-0.63) and subcutaneous fat areas (r2 =0.69- 0.71), (p In multivariable linear regression, independent predictors of muscularity (i.e. T4 muscle index) were age (p=0.005), sex (p=0.000), BMI (p=0.000) and HCT-CI (p=0.057). Disease severity (Armand DRI) (p=0.131) was not significantly associated with T4 muscle index. Similar conclusions were obtained for L3 muscle index. In multivariable linear regression adjusted for sex (p=0.000), age (p=0.000) and HCT-CI (p=0.000) and both T4 muscle index (b 0.252 [95%CI 0.126;0.412] p=0.000) and T4 muscle radiodensity (b 0.165 [95%CI 0.110;0.630] p=0.006) were independently associated with FEV1; Armand DRI (p=0.712) and KPS (p=0.991) were not associated with FEV1. Similar conclusions were obtained when muscle index and radiodensity at L3 were considered. Discussion and Conclusion Lumbar or thoracic CT images are useful for body composition assessment in this population, and reveal high rates of sarcopenia, similar to those reported in very elderly patients. Reduced muscle mass and radiodensity associate with impaired FEV1. More muscular patients were male, younger, of high BMI and had fewer comorbidities.