Exploratory association of muscle and adipose tissue indices with clinical outcomes in aggressive lymphomas

Abstract Background Muscle and adipose tissue quantified on computed tomography (CT) are associated with overall survival (OS), toxicity, and quality of life (QOL) in solid tumor malignancies. This study sought to evaluate the association of body composition with outcomes in older adult aggressive non‐Hodgkin lymphoma (aNHL). Methods The authors conducted a longitudinal study of 105 adults ≥65 years old with aNHL receiving chemoimmunotherapy. They performed body composition analysis on pretreatment CTs (third lumbar vertebral level using validated, fully automated pipeline and manual quality control). They derived skeletal muscle (SMI), subcutaneous and visceral adipose tissue indices (SATI and VATI) and calculated corresponding age‐adjusted and sex‐adjusted z scores. They conducted univariate and multivariable (controlling for International Prognostic Index) regression models evaluating the association of body composition with OS, grade 3+ nonhematologic toxicity (tox), unplanned hospitalization (UH), and QOL (FACT‐Lym) decline (QOLD). Results Eighty‐seven patients had imaging available for analysis. In univariate analyses, higher SATI z score had numerically higher odds of tox (odds ratio [OR], 1.77; p < .01) and UH (OR, 1.67; p = .01), and numerically more QOLD (OR, 1.58; p = .06). No association was observed for VATI z score. Higher SMI z score had numerically better OS (hazard ratio [HR], 0.47; p = .04) and numerically lower odds of QOLD (OR, 0.52; p = .07). In multivariable analyses, higher SMI z score (HR, 0.50; p = .05) had numerically better OS, whereas higher SATI z score (OR, 1.89; p < .01) had numerically higher odds of tox. Conclusion In this exploratory analysis of older patients with aNHL, body composition on baseline CT was associated with OS and tox, underscoring imaging’s potential for risk stratification.