Influence of body composition assessed by computed tomography on mortality in older adults undergoing hematopoietic stem cell transplantation

• Published in: Nutrition in clinical practice
• Main Authors: Koch, Ludmila de Oliveira Muniz, Pereira, Andrea Z, Hamerschlak, Nelson, Castro, Adham do Amaral E, Tachibana, Adriano, Victor, Elivane da Silva, Filho, Reynaldo Jesus Garcia
• Format: Journal Article
• Language: English
• Published: United States 01.12.2022
• Subjects: computed tomography; body composition; graft-vs-host disease; older adults, stem cell transplantation; morbidity; survival
• ISSN: 1941-2452
• DOI: 10.1002/ncp.10808

The incidence of most hematologic malignancies increases with age. Hematopoietic stem cell transplantation (HSCT) provides a potentially life-prolonging or curative option for many patients in this scenario. Limited data assessed from computed tomography (CT) images are available on muscle mass and density outcomes after HSCT. We evaluate the influence of body composition on morbidity and mortality in older adults undergoing HSCT. Retrospective longitudinal study conducted with 50 patients ≥ 60 years old undergoing HSCT. Body composition was assessed by chest CT (CCT), and treatment-related mortality, graft-vs-host disease (GVHD), neutrophil grafting, and overall survival were analyzed. 148 HSCT patients were evaluated; 50 patients were eligible: 60% with autologous and 40% with allogeneic transplantation. Body mass index in patients was (female: 26.9 ± 4.7 kg/m ; male: 30.1 ± 4.9 kg/m ) - autologous and, (female: 24.3 ± 5.1 kg/m ; male: 26.4 ± 2.0 kg/m ) - allogeneic. In the autologous group, we found a positive association between age and death risk, with 63.5% increased risk of death (P = 0.006), and also Karnofsky Performance Score, with a 11.9% decrease in death risk (P < 0.001). A negative association between muscle radiodensity and death risk was observed in patients who received an allogeneic transplantation, with a risk decrease of 20.1% (P = 0.032). We found a positive association between the fourth thoracic vertebra muscle area and radiodensity and risk of acute GVHD (P = 0.028). Body composition assessed by CCT showed the importance of radiodensity for better prognosis.