Body Composition Factors in Myeloma Spectrum Patients that Predict Morbidity, Mortality, and Progression: Opportunistic Screening Using Whole Body Low Dose CT

拟议的研究项目旨在建立骨髓瘤谱系中发病率、死亡率和疾病进展的预测模型，范围从意义不明的单克隆伽玛病到（阴发）多发性骨髓瘤。在本研究中，身体成分测量将通过全身低剂量CT扫描获得，利用2017年7月至今在宿主机构进行的约430次CT扫描。回顾性分析全身低剂量CT扫描，并在选定的胸椎（T3、T5、T7）和腰椎（L4）水平进行二维身体成分分析。身体成分测量包括对总脂肪组织、皮下和内脏脂肪组织、肌间脂肪组织、肌肉组织和椎骨的横截面积和密度的量化和评估。这些测量将使用经过验证的分割算法进行。随后，测量结果将被平均，并根据患者体重、身高、年龄和性别作为身体成分标记进行索引。患者结局，包括进展时间、住院天数、化疗反应、不良反应、骨折、无进展生存期和总生存期，将被记录下来，并与患者和疾病特征以及身体成分标志物相关。通过多变量分析建立预测模型。该研究与常规临床实践相一致，当怀疑骨髓瘤谱系疾病时，应定期进行全身低剂量CT检查，允许机会性筛查，而不会给患者带来额外的风险。通过利用这些扫描的身体成分测量，该研究旨在确定具有预测价值的额外身体成分标记物，潜在地改善对疾病进展和患者结果的预测，这可能导致患者管理和治疗策略的增强。

The proposed research project aims to establish predictive models for morbidity, mortality, and disease progression in the myeloma spectrum, ranging from monoclonal gammopathy of undetermined significance to (smoldering) multiple myeloma. For this study, body composition measurements will be obtained from whole body low dose CT scans, utilizing approximately 430 CT scans performed at the host institution between July 2017 and the present. The whole body low dose CT scans will be retrospectively analyzed and 2D body composition analysis will be performed on selected thoracic (T3, T5, T7) and lumbar (L4) levels. The body composition measurements comprise the quantification and assessment of the cross sectional area and density of total adipose tissue, subcutaneous and visceral adipose tissue, intermuscular adipose tissue, muscle tissue and vertebral bone. These measurements will be performed using validated segmentation algorithms. Subsequently, measurements will be averaged and indexed as body composition markers based on patient weight, patient height, age, and gender. The patient outcomes, including time to progression, days of hospitalization, chemotherapy response, adverse effects, fractures, progression-free survival, and overall survival, will be documented and correlated with patient and disease characteristics and body composition markers. Multivariate analyses will be conducted to establish predictive models. This proposed study aligns with routine clinical practice as whole body low dose CT is indicated and regularly performed when suspecting myeloma spectrum disease, allowing for opportunistic screening without additional risk to the patients. By utilizing body composition measurements from these scans, the study aims to identify additional body composition markers with predictive value, potentially improving the prediction of disease progression as well as patient outcomes, which may lead to an enhancement of patient management and treatment strategies.