SARCOPENIA IS AN INDEPENDENT PROGNOSTIC FACTOR IN ELDERLY MALE PATIENTS WITH CLASSICAL HODGKIN LYMPHOMA: RESULTS FROM A MULTICENTER EXPERIENCE

Abstract

Introduction: Classical Hodgkin Lymphoma in the elderly (ecHL) is a rare disease with dismal prognosis and no standard treatment. In elderly lymphoma patients (pts) functional status evaluation helps define different prognostic subgroups and may be useful to design appropriate treatments. Sarcopenia has been associated with worse survival in various solid tumors, but its impact in ecHL is unknown. The aim of this retrospective multicenter study was to investigate the prognostic role of sarcopenia in ecHL. Methods: We retrospectively analyzed ≥65 years old ecHL pts treated at 4 participating centers, who performed a baseline comprehensive geriatric assessment (CGA) and high-dose computed tomography (CT) or positron emission tomography/CT (PET/CT) before any treatment. Sarcopenia was measured as skeletal muscle index (SMI, cm2/m2) by the analysis of high dose CT or low-dose PET/ CT images at the L3 level. The specific cut-offs for the SMI were determined by receiver operator curve (ROC) analysis and compared with those studied in Diffuse Large B Cell Lymphoma (DLBCL) pts (Lanic et al, Leuk Lymphoma 2014; Nakamura et al, Ann Hematol 2015). Survival functions (Progression Free Survival, PFS; Overall Survival, OS) were calculated for the whole population and for different subgroups defined as per different sarcopenia cut-off levels. Results: One hundred and fifty-four pts (median age 71y, 76 females) were included in the study. The median L3-SMI was 42 cm2/m2. The specific cut-off derived in our male population was 45 cm2/m2; using this cut-off, 27 male pts (35%) were defined as sarcopenic. After a median follow-up of 5.9 years, the overall 5-year PFS and OS rates were 53% and 65%, respectively, and were significantly shorter in sarcopenic males compared to non-sarcopenic (PFS 31% vs 61%, p = 0.008; OS 51% vs 74%, p = 0.042) [Figure 1]. Applying DLBCL-derived sarcopenic thresholds, there were no significant differences between sarcopenic and non-sarcopenic pts for both PFS and OS, with a sole exception of a significant reduced PFS in sarcopenic male pts using Namakura-cut off. The CGA-determined frail functional status was an independent adverse prognostic factor for both female and male pts. Conclusions: Baseline evaluation of sarcopenia through radiological examinations performed for ecHL staging may help define a proportion of male pts with unfavorable outcome with current treatment strategies. Also the functional status evaluation could allow to identify a frail subgroup of pts with worse outcome. Prospective studies are warranted to better define the effective role and utility of this approach in the setting of ecHL.