Phase Angle and Body Composition As a Prognostic Factor in Acute Lymphoblastic Leukemia
Phase Angle and Body Composition As a Prognostic Factor in Acute Lymphoblastic Leukemia
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DOI：
10.1182/blood-2023-185264
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发表时间：
2023-11-02
期刊：
影响因子：
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通讯作者：
Jose Ramiro Espinoza Zamora
中科院分区：
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作者：
Victor Itaí Urbalejo Ceniceros;Dana Aline Perez Camargo;Erendira Baltazar Luna;Omar Eduardo Fernandez Vargas;Mistral Castellanos Mares;Patricia Carolina Figueroa Hernandez;Nidia Paulina Zapata;Jose Ramiro Espinoza Zamora
急性淋巴细胞白血病（ALL）是一种在分化早期被阻断的淋巴细胞恶性增殖，可侵入骨髓、血液和髓外部位。年龄特定发病率在 1-4 岁儿童中最高，然后在儿童期（5-14 岁）、青春期和成年早期（AYA）（15-39 岁）急剧下降，在 25 岁至 45 岁之间达到最低点。 生物电阻抗分析（BIA）是一种用于估计身体成分和细胞膜完整性的方法。 BIA 是一种有用的工具，因为它是非侵入性的，相对便宜，几乎可以对任何患者进行，不会使患者暴露于电离辐射，无痛，并且具有较高的观察者内和观察者间精度（变异系数 = 2.7%-4.0%）。相位角（PhA）是通过BIA获得的，与细胞功能相关。它被认为是营养不良的可靠标志。 PhA 已被证明可以预测实体恶性肿瘤和造血干细胞移植患者的生存率。 迄今为止，尚无研究评估 PhA 在 ALL 患者中的使用情况。因此，这项回顾性研究旨在确定基线 PhA 和瘦体重指数对新诊断接受强化化疗的 ALL 患者的 OS 和 LFS 的预后意义。 回顾性、横断面、观察性和描述性研究。对2019年1月至2023年1月接受强化化疗的患者记录进行了审查。 统计分析 定性变量按频率和比例进行研究，定量变量按中位数和范围分组。 OS 和 LFS 使用 Kaplan-Meier 生存曲线和 log-Rank 确定，显着性 p <0.05 值。使用 SPSS 25 版和 GraphPad Prism 9.5.0 版进行统计分析。 结果 纳入 85 名患者，其中男性 56.7%（48 名），女性 43.5%（37 名）。 79 名 ALL-B 患者和 6 名 ALL-T 患者。平均年龄为 25 岁。 68 名是 AYA 人群，17 名不是 AYA。 CR 为 89%，ND MRD 为 57%。 AYA 的化疗是 CALGB 10403，而不是 AYA 的化疗是 Hyper-CVAD。 38% 的患者出现复发。平均体重指数为26.98±5.27 kg/m 2。平均PhA为4.547±0.9983°。平均去脂质量指数为 17.8 (12.9-35.5) kg/m 2 。平均脂肪质量指数为 9.195±4.425 kg/m 2 。1 年平均 OS 为 86% ，3 年 OS 为 64.5% 。 通过 Kaplan Meier 曲线比较，LFS 具有统计学显着性的结果为：男性与女性 p=0.0344，PhA >4，p=0.0235，瘦体重指数 ≥16，p=0.0111。 结论 总之，我们的研究结果表明，在接受强化诱导化疗的新诊断 ALL 患者中，PhA 可能为 LFS 和 OS 提供重要的预后信息。 PhA 是针对 ALL 患者的客观、可重复、高精度的测量方法，与该人群的其他预后因素不同，PhA 可能需要进行干预。 ALL 患者 PhA 的未来研究应解决相位角的内容有效性，同时进一步探索力量训练和营养补充对 PhA 和患者预后影响的有希望的发现。
Acute lymphoblastic leukaemia (ALL) is a malignant proliferation of lymphoid cells blocked at an early stage of differentiation that can invade bone marrow, blood, and extramedullary sites. Age specific incidence is highest in children aged 1-4 years, then drops sharply through childhood (5-14 years), adolescence and young adulthood (AYA) (15-39 years), reaching the lowest point between 25 years and 45 years. Bioelectrical impedance analysis (BIA) is a method used to estimate body composition and cell membrane integrity. BIA is a useful tool as it is non-invasive, relatively inexpensive, can be performed on nearly any patient, does not expose the patient to ionizing radiation, is painless, and has both high intra and inter observer precision (coefficient of variation = 2.7%-4.0%). Phase angle (PhA) is obtained by BIA and is associated with cellular function. It is considered a reliable marker of malnutrition. PhA has been shown to predict survival in solid malignancies and hematopoietic stem cell transplant patients. To date, no studies have evaluated the usage of PhA in ALL patients. Therefore, this retrospective study sought to establish the prognostic significance of baseline PhA and lean mass index on OS and LFS in newly diagnosed ALL patients receiving intensive chemotherapy. Retrospective, cross-section, observational and descriptive study. The records of patients who received intensive chemotherapy from January 2019 to January 2023 were reviewed. Statistical analysis The qualitative variables were studied in frequencies and proportions, the quantitative variables were grouped into medians and ranges. OS and LFS were determined using Kaplan-Meier survival curves with log-Rank with a significant p <0.05 value. Statistical analysis was performed with SPSS version 25 and GraphPad Prism version 9.5.0. Results 85 patients were included, 56.7% (48) men and 43.5% (37) women. 79 patients with ALL-B and 6 patients ALL-T. The mean age was 25 years. 68 were AYA population and 17 not-AYA. The CR was 89%, ND MRD was 57%. The chemotherapy for AYA was CALGB 10403, and not AYA was Hyper-CVAD. Relapse was documented in 38%. The mean body mass index was 26.98±5.27 kg/m 2. The mean PhA was 4.547±0.9983°. The mean lean mass index was 17.8 (12.9-35.5) kg/m 2. The mean fat mass index was 9.195±4.425 kg/m 2. The mean OS was 86% at 1 year and OS at 3 years was 64.5%. The results that were statistically significant in LFS compared by Kaplan Meier curves were: male vs female p=0.0344, PhA >4, p=0.0235, lean mass index ≥16, p=0.0111. Conclusions In conclusion, our findings suggest that in newly diagnosed ALL patients undergoing intensive induction chemotherapy, PhA may provide important prognostic information for LFS and OS. PhA is an objective, repeatable, high-precision measure in ALL patients and, unlike other prognostic factors in this population, is potentially subject to intervention. Future studies of PhA in ALL patients should address the content validity of phase angle while further exploring the promising findings of the effect of strength training and nutritional supplementation on PhA and patient outcomes.