Evolution of Body Composition Following Autologous and Allogeneic Hematopoietic Cell Transplantation: Incidence of Sarcopenia and Association with Clinical Outcomes
Evolution of Body Composition Following Autologous and Allogeneic Hematopoietic Cell Transplantation: Incidence of Sarcopenia and Association with Clinical Outcomes
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DOI：
10.1016/j.bbmt.2018.02.016
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发表时间：
2018-08-01
影响因子：
4.3
通讯作者：
Fintelmann, Florian J.
中科院分区：
文献类型：
--
作者：
DeFilipp, Zachariah;Troschel, Fabian M.;Fintelmann, Florian J.
肌肉减少症（肌肉质量的损失）已被确定为造血细胞移植（HCT）受者不良结局的潜在风险因素。然而，关于HCT后身体组成的变化仍有许多未知之处。我们回顾性评估了2000年至2014年期间在我们机构接受HCT的315名淋巴瘤患者的计算机断层扫描（CT）成像。在HCT前、HCT后1年和HCT后2.5年，在CT上测量第三腰椎椎体水平的瘦肌、皮下脂肪组织和内脏脂肪组织的横截面积。HCT前肌肉减少症的发生率在自体HCT（auto-HCT）队列（n = 218）中为47%，在同种异体HCT（allo-HCT）队列（n = 97）中为55%。年龄较大（比值比[OR]，1.04; 95%可信区间[CI]，1.01 - 1.04; P <0.001）和男性（OR，4.59; 95% CI，1.42 - 4.93; P <0.001）与HCT前肌肉减少症相关。增加体重指数（OR，0.78; 95%CI，0.73至0.84; P <0.001）可预防HCT前的肌肉减少症。与auto-HCT队列的趋势相比，allo-HCT队列中的患者随时间推移总瘦体重显著下降（3= 1.96; 95%CI，0.79至3.13; P = 0.001），肌肉减少症发生率增加（OR，1.72; 95%CI，1.13至2.62，P = 0.012）。随着时间的推移，auto-HCT和allo-HCT接受者的总体脂量均有所增加（β = 3.75; 95%CI，2.77至4.73; P < .001）。在对接受alto-HCT的患者进行的多变量分析中，HCT前基线影像学检查时存在肌肉减少症与急性移植物抗宿主病风险较低相关（OR，0.30; 95%CI，0.09至0.98; P= 0.047）。总之，我们发现auto-HCT和allo-HCT后全身脂肪质量均增加。在allo-HCT之后，总瘦体重显著降低，对应于肌肉减少症的发生率增加。未来的研究需要进一步描述HCT接受者身体成分的变化，并调查其对HCT结果的影响。(C)2018年美国血液和骨髓移植协会。
Sarcopenia, the loss of muscle mass, has been identified as a potential risk factor for adverse outcomes in hematopoietic cell transplantation (HCT) recipients. However, much remains unknown about change in body composition following HCT. We retrospectively evaluated computed tomography (CT) imaging from 315 lymphoma patients undergoing HCT at our institution between 2000 and 2014. Cross-sectional areas of lean muscle, subcutaneous adipose tissue, and visceral adipose tissue were measured on CT at the level of the third lumbar vertebral body before HCT, 1-year post-HCT, and 2.5 years post-HCT. The incidence of sarcopenia before HCT was 47% in the autologous HCT (auto-HCT) cohort (n = 218) and 55% in the allogeneic HCT (allo-HCT) cohort (n = 97). Older age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01 to 1.04; P < .001) and male sex (OR, 4.59; 95% CI, 1.42 to 4.93; P < .001) were associated with sarcopenia before HCT. Increasing body mass index (OR, .78; 95% CI, .73 to .84; P < .001) was protective against sarcopenia before HCT. A significant decline in total lean body mass ((3= 1.96; 95% CI, .79 to 3.13; P = .001) and increased sarcopenia incidence (OR, 1.72; 95% CI, 1.13 to 2.62, P = .012) was observed over time for patients in the allo-HCT cohort when compared with the trend in the auto-HCT cohort. Both auto-HCT and allo-HCT recipients experienced an increase in total body fat mass over time (beta = 3.75; 95% CI, 2.77 to 4.73; P < .001). In multivariate analysis of patients undergoing alto-HCT, the presence of sarcopenia on baseline imaging before HCT was associated with a lower risk of acute graft-versus-host disease (OR, .30; 95% CI, .09 to .98; P= .047). In conclusion, we found that total body fat mass increases after both auto-HCT and allo-HCT. Following allo-HCT, total lean body mass significantly decreases corresponding to increased incidence of sarcopenia. Future studies are needed to further characterize changes in body composition in HCT recipients and investigate its impact on HCT outcomes. (C) 2018 American Society for Blood and Marrow Transplantation.