Low skeletal muscle mass and treatment outcomes among adults with haematologic malignancies: A systematic review and meta-analysis

Nadia M Anabtawi; Monica Sai Pasala; Alyssa A Grimshaw; Prakash Kharel; Susan Bal; Kelly Godby; Ashmita Siwakoti; Thomas W Buford; Smita Bhatia; Luciano J Costa; Grant R Williams; Smith Giri

doi:10.1002/jcsm.13446

Low skeletal muscle mass and treatment outcomes among adults with haematologic malignancies: A systematic review and meta-analysis

J Cachexia Sarcopenia Muscle. 2024 Apr 1. doi: 10.1002/jcsm.13446. Online ahead of print.

Authors

Nadia M Anabtawi¹, Monica Sai Pasala¹, Alyssa A Grimshaw², Prakash Kharel³, Susan Bal⁴, Kelly Godby⁴, Ashmita Siwakoti⁵, Thomas W Buford^{6

7}, Smita Bhatia⁸, Luciano J Costa⁴, Grant R Williams^{4

8}, Smith Giri^{4

8}

Affiliations

¹ School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
² Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA.
³ Department of Hospital Medicine, Geisinger Health System, Geisinger, Danville, PA, USA.
⁴ Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.
⁵ Department of Medicine, University of Kentucky, Lenxtington, KY, USA.
⁶ Department of Medicine, Division of Gerontology, Geriatrics & Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA.
⁷ Birmingham/Atlanta VA GRECC, Birmingham VA Medical Center, Birmingham, AL, USA.
⁸ Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA.

PMID: 38558541
DOI: 10.1002/jcsm.13446

Abstract

Background: Low skeletal muscle mass (LSMM) and/or, function associated with an increased risk of treatment-related toxicities and inferior overall survival (OS) among adults with solid malignancies. However, the association between LSMM and treatment-related toxicities among adults with haematologic malignancies remains unclear.

Methods: Using a pre-published protocol (CRD42020197814), we searched seven bibliographic databases from inception to 08/2021 for studies reporting the impact of LSMM among adults ≥18 years with a known haematologic malignancy. The primary outcome of interest was OS, and secondary outcomes included progression free survival (PFS) and non-relapse mortality (NRM). These effect sizes were quantified in terms of hazards ratio (HR) along with 95% confidence interval (CI) and pooled across studies using a DerSimonian-Laird random-effects model. Heterogeneity was assessed using the Cochran's Q and the I² statistic. All hypothesis testing was two-sided with an alpha of 0.05.

Results: Of 3791 studies screened, we identified 20 studies involving 3468 patients with a mean age of 60 years; 44% were female and the most common malignancy was diffuse large B-cell lymphoma (42%). Most studies measured muscle mass using single slice computed tomography imaging at the L3 level. The presence of LSMM was associated with worse OS (pooled HR = 1.81, 95% CI = 1.48-2.22, P < 0.001) with moderate heterogeneity (Cochran's Q, I² = 60.4%), PFS (pooled HR = 1.61, 95% CI = 1.28-2.02, P < 0.001) with moderate heterogeneity (Cochran's Q, I² = 66.0%). Similarly, LSMM was associated with worse NRM (HR = 1.72, 95% CI = 1.34-2.22, P < 0.001) with little evidence of heterogeneity (Cochran's Q, I² = 0.0%).

Conclusions: LSMM is associated with worse survival outcomes among adults with haematologic malignancies. Further research into understanding the underlying mechanism of this association and mitigating the negative effects of LSMM among adults with haematologic malignancies is needed.

Keywords: Adverse outcomes; Muscle mass; Prognostication; Sarcopenia; Toxicities.

Grants and funding

K08CA234225/University of Alabama at Birmingham and the National Cancer Institute of the National Institutes of Health